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Rizk El-Galley

Publications and source records attributed to Rizk El-Galley.

10 recordsLinked to original sources
PubMed2006

EUS-guided FNA for the diagnosis of recurrent bladder cancer through the ileal conduit: a novel approach.

BACKGROUND: Diagnosing local recurrence of tumor after cystectomy and ileal conduit construction for urinary bladder cancer remains a diagnostic challenge. Also, distinction of benign stricture from recurrent tumor at the site of ureteral anastomosis in the ileal conduit is difficult. OBJECTIVE: A new method is described for performing EUS-guided FNA through the ileal conduit in patients suspected of having local tumor recurrence after complete cystectomy for bladder cancer. DESIGN: Case series, part of a large prospective study on EUS-guided FNA. PATIENTS: Three patients who had undergone total cystectomy and ileal conduit construction for bladder cancer underwent EUS-guided FNA through the ileal conduit for evaluation of suspected tumor recurrence at the site of anastomosis of the distal ureter and the ileal conduit. MAIN OUTCOME MEASUREMENTS: The feasibility, diagnostic accuracy, and safety profile of EUS-guided FNA is assessed. OBSERVATIONS: EUS-guided FNA through the ileal conduit was technically feasible in all 3 patients. By EUS, the mass appeared as an irregularly shaped, hypoechoic lesion that was extrinsic to the lumen of the ileum. A diagnosis of recurrent transitional cell cancer was made in 2 patients and anastomotic stricture was found in 1 patient. Both patients with tumor recurrence received palliative chemotherapy, and the patient with an anastomotic stricture was managed by placement of a nephrostomy stent. No complications were encountered. LIMITATIONS: Small number of enrolled subjects; short duration of follow-up. CONCLUSIONS: EUS-guided FNA through the ileal conduit is technically feasible, safe, and establishes diagnosis in patients suspected of tumor recurrence after complete cystectomy for bladder cancer.

Aged↗
PubMed2005

Retrograde stenting for obstruction of the renal transplant ureter.

OBJECTIVES: To present our experience with retrograde stent placement and stent exchange for transplant ureteral obstruction. METHODS: A review of our renal transplant database was performed to identify all renal transplant patients who underwent attempted retrograde ureteral stenting for allograft ureteral obstruction or attempted allograft ureteral stent exchange between May 1992 and April 2004. A retrospective review was performed. RESULTS: Forty patients underwent 52 attempted retrograde ureteral stent placements, and 11 patients underwent a total of 27 attempted stent exchanges. In patients with ureteral obstruction, the most common clinical signs and symptoms were nausea, vomiting, diarrhea, abdominal pain, fever, decreased urine output, edema, and an elevated serum creatinine. Of the 52 cases of allograft ureteral obstruction and attempted retrograde ureteral stent placement, 28 (53.8%) were managed successfully with retrograde ureteral stenting. Of the 27 attempted stent exchange procedures, a successful exchange was accomplished in 23 cases (85.2%). CONCLUSIONS: Cystoscopy with retrograde allograft stent placement is a reasonable first approach to the management of transplant ureteral obstruction and is successful in more than one half of cases.

Adult↗
PubMed2005

Laparoscopic right nephrectomy using a novel technique to excise an inferior vena-caval cuff in a porcine model.

BACKGROUND AND PURPOSE: Laparoscopic right nephrectomy has been performed using laparoscopic staplers to clamp and divide the renal vessels. In patients who have a tumor thrombus in the renal vein and in rightkidney donors, it is necessary to excise a cuff of the inferior vena cava (IVC) with the renal vein. We present a new technique for excising a cuff of the IVC and suturing it intracorporally using a new vascular clamp designed in our institution. MATERIALS AND METHODS: The vascular clamp was designed to be completely inserted into the peritoneal cavity through the hand-port incision. The renal vein with a cuff of the IVC was then excised, and the defect in the IVC was sutured with a vascular stitch intracorporally. This procedure was performed in the animal laboratory using a porcine model. RESULTS: A total of 20 hand-assisted right laparoscopic nephrectomies were performed. In the first five operations, the clamp dimensions and angles were modified until the ideal design was reached. In the next five operations, different suture materials and needle sizes were tried to find the best combination for the intracorporal IVC sutures. The first and second operations were not completed because of the difficulty in applying the initial version of the clamp to the IVC. In the 4th and 6th operations, bleeding occurred from the suture line: because of a missed stitch in the back wall of the IVC in one case and a needle stick to the IVC in the other case. The last 14 operations were successful without any bleeding or injuries. Suturing of the IVC was completed in 13 to 22 minutes. CONCLUSION: Right hand-assisted laparoscopic nephrectomy with excision of a cuff of the IVC using an intracorporal vascular clamp is safe and reproducible in a porcine model. In our hands, a learning curve of 10 cases was required.

Animals↗
PubMed2004

Donor nephrectomy: A comparison of techniques and results of open, hand assisted and full laparoscopic nephrectomy.

PURPOSE: Laparoscopic donor nephrectomy (LAP) has been gaining more popularity among kidney donors and transplant surgeons. There have been some concerns about the function of kidney grafts harvested by laparoscopic procedures. We report our results of LAP. MATERIALS AND METHODS: Prospective data were collected for our donor nephrectomy operations. A telephone survey was done by an independent investigator on the impact of surgery on quality of life. Graft function was also evaluated by serial serum creatinine and mercaptoacetyltriglycine renal nuclear scans. RESULTS: A total of 100 patients were included in the study; of whom 55 underwent open donor nephrectomy (OD), 28 underwent LAP and 17 underwent hand assisted donor nephrectomy (HAL). Mean patient age was 39 +/- 12 years and it was similar in all groups. Mean operative time was 306 +/- 40 minutes for LAP, 294 +/- 42 minutes for HAL and 163 +/- 24 minutes for OD (p = 0.001). Laparoscopic operative time was decreased to 180 +/- 56 minutes for LAP and 155 +/- 40 minutes for HAL in the last 10 patients. Mean estimated blood loss was 200 +/- 107 cc for LAP, 167 +/- 70 cc for HAL and 320 +/- 99 cc for OD (p = 0.0001). Mean warm ischemia time was 3 +/- 2 minutes for LAP, 2 +/- 2 minutes for HAL and 2 +/- 1 minutes for OD (p = 0.002). Postoperative hospitalization was 2 +/- 2 days for LAP and 3 +/- 2 days for OD (p = 0.01). LAP required 30% less narcotic medicine than OD postoperatively (p = 0.04). There were no major complications in LAP cases and no complete or partial graft loss was noted. Mean followup was 7 months. Recipient creatinine was not significantly different for kidneys harvested by LAP or OD (p = 0.5). Diuretic mercaptoacetyltriglycine renograms were performed in all recipients 1 to 3 days after surgery and mean effective renal plasma flow was similar for the 3 groups (p = 0.9). According to telephone survey results 85% of LAP, 71% of HAL and 43% of OD patients reported a return to normal physical activity within 4 weeks after surgery. Similarly 74% of LAP, 62% of HAL and 26% of OD patients were able to return to work within 4 weeks after surgery. CONCLUSIONS: Our data show no significant difference in graft function between LAP and OD. LAP and HAL were safe and complications were minimal. The main difference was that patients treated with LAP and HAL returned to normal physical activity and work significantly earlier than those who underwent OD.

Adult↗
PubMed2003

Surgical management of renal tumors.

Renal cell carcinoma is a relatively rare tumor, accounting for approximately 3% of malignancies in adults, but is the most common tumor of the kidney and the third most common tumor seen by urologists. Renal cell carcinoma is refractory to most traditional oncologic treatments, including chemotherapy, radiation therapy, and hormonal therapy. Because of recent advances in sophisticated radiologic studies, the surgeon can now make an accurate preoperative assessment of the nature and extent of kidney tumors. When evaluating renal tumors, the urologist looks for certain information to help in constructing a management plan. This article explores some of the points that contribute in the surgical decision-making.

Carcinoma, Renal Cell↗
PubMed2002

Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy.

OBJECTIVES: To evaluate the usefulness of follow-up radiographic studies after ureteroscopy by retrospective chart review. METHODS: We reviewed the charts of 118 patients who underwent 134 ureteroscopic procedures from January 1998 to November 1999. RESULTS: Follow-up was obtained at our institution for 87 patients. The follow-up period ranged from 3 to 34 weeks (mean 7, SE +/- 0.75). Of 10 patients who underwent ureteroscopy for diagnostic purposes, none had postoperative pain or obstruction on follow-up radiographic studies. Of 77 patients who underwent ureteroscopy for calculi, 12 (16%) had postoperative obstruction. One third of patients with residual obstruction (4 of 12) complained of persistent pain versus 6% of patients without evidence of obstruction (4 of 65) (P = 0.02). Twelve patients had residual stone fragments on their follow-up radiographic studies; 5 (42%) of these patients complained of pain versus 3 (5%) of 65 patients who were stone free after surgery (P = 0.002). The use of pain to predict either obstruction or residual fragments had a negative and positive predictive value of 83% and 75%, respectively. Preoperative obstruction and postoperative pain were combined as one indicator for the presence of residual fragments and postoperative obstruction. Patients who had preoperative obstruction and presented with postoperative pain had a 67% chance of having residual fragments and a 50% chance of residual obstruction, and 96% of patients without preoperative obstruction and no postoperative pain had no persistent obstruction or residual fragments (P = 0.001). CONCLUSIONS: For patients who present for ureteroscopy with no obstruction and report no pain at follow-up, a plain radiograph may be sufficient. For patients who present with obstruction and report pain during follow-up, functional imaging studies are recommended.

Adult↗
PubMed2002

Radical prostatectomy in a community practice.

PURPOSE: We report the experience of a community based urologist with anatomical retropubic radical prostatectomy. We compared outcome data with that reported experience at several well-known academic institutions. MATERIALS AND METHODS: Between May 1986 and December 2000, 382 consecutive patients underwent anatomical radical retropubic prostatectomy performed by a single community based urologist. Charts were reviewed to determine the positive margin rate, urinary continence, potency, hospitalization and the prostate specific antigen (PSA) recurrence rate. RESULTS: The positive margin rate was 9% overall but in the last 5 years it was 7% compared with 7% to 40% in previous studies at academic institutions. The urinary continence rate was 90% overall and 93% in the last 5 years when excluding men older than 70 years old, compared with 85% to 94% in the academic urological literature. The potency rate after the bilateral nerve sparing technique was 79% compared with 54% to 86% in academic series. Average hospitalization in the last 5 years was 1.5 days. Overall PSA recurrence rate and the rate of PSA recurrence as a function of preoperative PSA, postoperative stage and grade were similar to those at academic institutions. CONCLUSIONS: Anatomical radical prostatectomy can be performed at nonacademic institutions with results comparable to those at academic institutions.

Adult↗
PubMedDate not supplied

Camptothecin analogues and vinblastine in the treatment of renal cell carcinoma: an in vivo study using a human orthotopic renal cancer xenograft.

To perform a series of in vivo cytotoxicity studies using a variety of doses of the comptothecin analogues 9-Aminocamptothecin (9-AC) and Irinotecan (CPT-11) with a human RCC xenograft tumor line (DU11983m). Using the subrenal capsule assay (80 nude mice) (NM-SRCA), 9-AC was evaluated at both low and high dosage levels (0.75 mg/kg and 1.25 mg/kg oral x10 doses over 12 days). Following an initial assessment of acute tumor inhibition, the study was extended to a survival assay with some cohorts receiving retreatment boluses on a once or twice weekly basis. CPT-11 was assessed at a dose of 100 mg/kg x3 over 9 days with weekly retreatment and two cohorts received 9-AC combined with Vinblastine (2.7 mg/kg) and Vinblastine alone, respectively. Tumor inhibition: tumor growth inhibition was significant (over 80%) with all cohorts receiving any camptothecin analogue and was virtually complete (>99% tumor inhibition) at the high dose 9-AC (1.25 mg/kg). Vinblastine alone achieved only moderate cytotoxic effect (46%) and induced the largest recorded cohort weight loss (toxicity). Survival analysis: the low and high dose 9-AC single agent cohorts were not significantly different; however, the CPT-11 cohort experienced maximal survival benefit. (P = 0.003) and the addition of Vinblastine did not enhance this survival advantage among the 9-AC cohorts. Control and single agent Vinblastine cohorts had the poorest survival with the treated group still surviving longer (P = 0.02). At 35 days after final assessment of acute tumor inhibition, all animals in both the control and Vinblastine alone cohorts were dead. None of the animals in any of the other cohorts (all of which had experienced a greater than 80% tumor inhibition) had died. No deaths occurred due to surgery or treatment toxicity and all deaths were deemed tumor related. CPT-11 and 9-AC produced a marked survival advantage in an orthotopic model of human advanced renal carcinoma and are identified as agents for further clinical assessment.

Animals↗