Biomedical subjects

Waleed Eassa

Publications and source records attributed to Waleed Eassa.

5 recordsLinked to original sources

PubMed2006

Treatment of renal stones in children: a comparison between percutaneous nephrolithotomy and shock wave lithotripsy.

PURPOSE: We compared the results of percutaneous nephrolithotomy and shock wave lithotripsy for the treatment of 1 to 2 cm renal stones in children. MATERIALS AND METHODS: The study included 166 children with renal stones 1 to 2 cm. A total of 75 patients (82 kidneys) were treated with percutaneous nephrolithotomy and 91 (93 kidneys) were treated with shock wave lithotripsy. Mean followup was 31 +/- 10 months (range 6 to 84). Both groups were compared regarding stone-free rate, re-treatment rate, complications and incidence of stone recurrence. RESULTS: Both groups were comparable regarding preoperative characteristics. Of the units treated with percutaneous nephrolithotomy 4 (4.9%) were associated with minor complications. Stone-free rate after a single session of percutaneous nephrolithotomy was 86.6% (71 units), and the remaining 11 kidneys with residual stones were successfully treated with repeat percutaneous nephrolithotomy in 7 and shock wave lithotripsy in 4. Therefore, a total of 78 units (95%) were stone-free after percutaneous nephrolithotomy monotherapy, and the overall stone-free rate at 3 months was 100%. Of the patients undergoing shock wave lithotripsy 1 (1.1%) had development of steinstrasse and was successfully treated with ureteroscopy. The overall re-treatment rate after shock wave lithotripsy was 55%. A total of 79 units (84.9%) were stone-free after shock wave lithotripsy monotherapy, whereas 7 (7.5%) with no gross response to treatment were treated with percutaneous nephrolithotomy and 7 with insignificant stones less than 4 mm were followed. Therefore, the overall stone-free rate at 3 months was 92.5%. The differences in stone-free rates and re-treatment rates significantly favored percutaneous nephrolithotomy, while the incidence of complications and stone recurrence at last followup were not significantly different between the groups. CONCLUSIONS: For treatment of 1 to 2 cm renal stones in children percutaneous nephrolithotomy is better than shock wave lithotripsy, yielding higher stone-free and lower re-treatment rates.

Adolescent↗

PubMed2004

Diagnosis of noncalcareous hydronephrosis: role of magnetic resonance urography and noncontrast computed tomography.

OBJECTIVES: To evaluate the role of magnetic resonance urography (MRU) and noncontrast computed tomography (NCCT) in the diagnosis of noncalcareous hydronephrosis when excretory urography (intravenous urography) is either contraindicated or inconclusive. METHODS: A total 108 consecutive patients with noncalcareous hydronephrosis were included in this study. In all patients, intravenous urography was either contraindicated or could not determine the diagnosis. In all patients, calculus obstruction was excluded by NCCT and all underwent heavily T2-weighted MRU. The final definitive diagnosis was established by retrograde or antegrade ureterography, endoscopy, or open surgery and was considered the reference standard for the diagnosis of obstruction. Normal kidneys in patients with unilateral obstruction were considered the reference standard for the absence of obstruction. The results of MRU were compared with those of NCCT regarding sensitivity, specificity, and overall accuracy. RESULTS: Of the 108 patients, 5 had bilateral obstruction and the remaining 103 had unilateral obstruction. Of the latter group, 5 had a solitary kidney; therefore, the total number of renal units was 211 (113 obstructed and 98 normal units). Ureteral strictures were identified by NCCT in 15 (28%) of 54 and by MRU in 45 (83%) of 54 patients. Bladder, ureter, or prostate tumors causing ureteral obstruction could be diagnosed in one half of the 54 patients with such tumors by NCCT (27 of 54) and in all but 2 patients by MRU (52 of 54). Both NCCT and MRU could identify all extraurinary causes of obstruction. Overall, of the 113 kidneys with noncalculus obstruction, the cause could be identified by MRU in 102 (sensitivity of 90%) and by NCCT in 47 (sensitivity of 42%), a difference of statistically significant value in favor of MRU (P <0.001). The specificity of T2-weighted MRU and NCCT was 100% and 99%, respectively (not a statistically significant difference). The overall accuracy of T2-weighted MRU and NCCT was 95% and 68%, respectively (P <0.001). CONCLUSIONS: In patients with ureteral obstruction in whom intravenous urography is not helpful and after NCCT has excluded stone disease, heavily T2-weighted MRU is a sensitive and specific method in the identification of the cause of obstruction.

Adult↗

PubMed2004

Diagnosis of ureteral obstruction in patients with compromised renal function: the role of noninvasive imaging modalities.

UNLABELLED: We compared the role of noncontrast computerized tomography (NCCT), magnetic resonance urography (MRU), and combined abdominal radiography (KUB) and ultrasonography (US) in the diagnosis of the cause of ureteral obstruction in patients with compromised renal function. MATERIALS AND METHODS: The study included 149 patients, of whom 110 had bilateral obstruction and 39 had obstruction of a solitary kidney. Therefore, the total number of renal units was 259. All patients had renal impairment with serum creatinine greater than 2.5 mg/dl. Besides conventional KUB and US all patients underwent NCCT and MRU. The gold standard for diagnosis of the cause of obstruction included retrograde or antegrade ureterogram, ureteroscopy and/or open surgery. The sensitivity, specificity and overall accuracy of NCCT, MRU, and combined KUB and US in the diagnosis of ureteral obstruction were calculated in comparison with the gold standard. RESULTS: The definitive cause of ureteral obstruction was calculous in 146 and noncalculous in 113 renal units, including ureteral stricture in 65, bladder or ureter in 43, extraurinary collection in 3 and retroperitoneal fibrosis in 2. The site of stone impaction was identified by NCCT in all 146 renal units (100% sensitivity), by MRU in 101 (69.2% sensitivity), and by combined KUB and US in 115 (78.7% sensitivity) with a difference of significant value in favor of NCCT (p <0.001). Ureteral strictures were identified by NCCT in 18 of the 65 cases (28%) and by MRU in 54 of 65 (83%). Bladder and ureteral tumors causing ureteral obstruction could be diagnosed in approximately half of the patients by NCCT (22 of 43) and in all except 1 by MRU (42 of 43). NCCT and MRU could identify all extraurinary causes of obstruction. Overall of the 113 kidneys with noncalculous obstruction the cause could be identified by MRU in 101 (89% sensitivity), by NCCT in 45 (40% sensitivity), and by combined KUB and US in only 20 (18% sensitivity) with a difference of significant value in favor of MRU (p <0.001). CONCLUSIONS: In patients with renal impairment due to ureteral obstruction NCCT has superior diagnostic accuracy for detecting calculous causes of obstruction but MRU is superior for identifying noncalculous lesions.

Adult↗

PubMed2002

Recoverability of renal function after relief of acute complete ureteral obstruction: clinical prospective study of the role of renal resistive index.

OBJECTIVES: To study the values of the renal resistive index (RI) before and at different points after relief of obstructive anuria and to correlate these values with the corresponding values of serum creatinine and with the recovery of renal function after release of obstruction. METHODS: A total of 32 consecutive patients with obstructive anuria were prospectively evaluated by measurement of RI before drainage and at 3 days, 1 week, 2 weeks, and 4 weeks after drainage. Serum creatinine was measured at all points of the RI examination. Moreover, RI was measured in an age and sex-matched control group of 24 consecutive healthy donors and volunteers. RESULTS: The study included 40 obstructed and 48 normal kidneys. In the obstructed kidneys, the mean RI values decreased significantly from 0.78 +/- 0.05 before drainage to 0.70 +/- 0.09 at 3 days after drainage (P <0.001) with an additional significant reduction to 0.68 +/- 0.08 at 7 days after drainage (P <0.01) and stabilized thereafter. Serum creatinine decreased significantly from 8.4 +/- 4.4 mg/dL before drainage to 4.7 +/- 3.8 mg/dL 3 days after drainage (P <0.001) and then to 3.6 +/- 3.7 mg/dL 7 days after drainage (P <0.001) and stabilized thereafter. The correlation between the RI and serum creatinine at the overall points of measurement was good. Obstructed kidneys were classified into two groups according to the recovery of renal function after obstruction relief: those that showed significant improvement of serum creatinine (24 kidneys, group 1) and those with no significant improvement of serum creatinine (16 kidneys, group 2). In group 1, the difference between the mean RI values before and after drainage was statistically significant (0.78 +/- 0.05 versus 0.64 +/- 0.06, P <0.001); in group 2, the difference between the before and after drainage RI values was not significant (0.781 +/- 0.040 versus 0.779 +/- 0.039). The mean RI of the normal kidneys was 0.66 +/- 0.04. A comparison between the mean RI values of the control group and the mean RI values of the obstructed patients after drainage showed no significant difference in group 1; markedly higher values were noted in group 2 at all points after drainage. CONCLUSIONS: In the setting of acute complete renal obstruction, the RI has a good positive correlation with serum creatinine. Recovery of renal function could not be predicted from the changes in RI before obstruction release. However, a reversal of a previously elevated RI could be used as an early indicator that renal function recovery is likely.

Adult↗

PubMed2002

Noncontrast computed tomography in obstructive anuria: a prospective study.

OBJECTIVES: To evaluate the role of noncontrast computed tomography (NCCT) in the determination of the cause of obstructive anuria and to compare its accuracy with that of the traditional methods of combined plain abdominal x-ray (KUB) and gray-scale abdominal ultrasonography (US). METHODS: The study included 40 consecutive patients with obstructive anuria. In addition to the routine evaluation, which included history, clinical examination, biochemical profile, KUB, and US, all patients underwent NCCT. The study patients were tested against an age and sex-matched control group that included the normal contralateral kidneys of 57 consecutive patients who underwent KUB, US, and NCCT for acute flank pain during the same study period. The reference standard for the determination of the cause of obstruction was retrograde or antegrade ureterography with or without ureteroscopy or open surgery. The absence of obstruction in the control group was confirmed by nonequivocal normal intravenous urography of the side free of flank pain. Both NCCT and combined KUB and US were compared regarding the sensitivity, specificity, and overall accuracy. RESULTS: The study group had 48 renal units, because obstruction was bilateral in 8 patients and of a solitary kidney in 32. Of the 42 renal units with calculus obstruction, the site of stone impaction was identified in all renal units by NCCT (sensitivity 100%) and in only 25 by combined KUB and US (sensitivity 59.5%)-a significant difference (P = 0.0001). Of the 6 renal units with noncalcular obstruction, both NCCT and US diagnosed the cause of obstruction in 3. The overall sensitivity of NCCT in the determination of the cause of obstructive anuria was 94% and that of combined KUB and US was 58%-a significant difference (P = 0.0001). The specificity of NCCT was not significantly different from that of combined KUB and US (96.5% versus 93%, respectively). The overall accuracy of NCCT was 95% and that of combined KUB and US was 77%-a significant difference (P = 0.0003). CONCLUSIONS: In patients with obstructive anuria, conventional KUB and US could not identify the cause of ureteral obstruction in about 40% of the patients. Under such conditions, NCCT can accurately provide the diagnosis, obviating the need of invasive and expensive diagnostic procedures.

Anuria↗