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Year : 2020  |  Volume : 12  |  Issue : 5  |  Page : 37-40  

Abstract - SUA202 (Trauma/ Reconstruction)

Date of Web Publication9-Jun-2020

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DOI: 10.4103/0974-7796.286039

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How to cite this article:
. Abstract - SUA202 (Trauma/ Reconstruction). Urol Ann 2020;12, Suppl S1:37-40

How to cite this URL:
. Abstract - SUA202 (Trauma/ Reconstruction). Urol Ann [serial online] 2020 [cited 2021 Sep 21];12, Suppl S1:37-40. Available from: https://www.urologyannals.com/text.asp?2020/12/5/37/286039

   Routine re imaging after renal injury: Is it necessary? Top

Abdullah Alkhayal1,2, Mohand Alzughaibi1, Faisal Alasmary2, Bandar Alommery2

1Urology Department, National Guard Hospital,2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

E-mail: [email protected]

Introduction: Kidneys are most commonly injured in trauma setting. Non operative management became the standard in most cases. Computed tomography scans ( CT) has been the modality of choice for the diagnosis and classification of renal injuries. the American urology association (AUA) for low grade ( Grade 1-3) injuries in the absence of clinical symptoms. In contrast, Grade 4-5 renal injuries should undergo reimaging again regardless of clinical situation.

Methodology: A total of 1230 cases of trauma that presented to national guard hospital in Riyadh were reviewed. Cases that had evidence of Renal injury on CT scan were included. We identified 122 cases. Patient files were reviewed for both Subjective and objective variables including: demographics, comorbidities, renal injury grade, hematoma size and surgical intervention. Computed Tomography scans were reviewed for all patient recording the grade of renal injury and hematoma size on presentation and on repeated imaging.

Results: Among 122 patients with evidence of renal injury in imaging done upon presentation, Grade IV renal injury was identified in 19 (15.7%) and Grade V was identified in 9 (7.4%). Imaging was repeated for all patients. The rate of upgrading in Grade IV patients was 0%, with majority of patients having same grade in repeated imaging. Surgical intervention was done only for 2 patients both of which were having Grade V injury and was carried out upon presentation.

Conclusion: Repeating images in grade 4 renal injuries should be guided by clinical indication rather than being done on routine.

   Retrospective study of recto urethral fistula repair with interposition of gracilis flap at tertiary care hospital Top

Muhammad Owais, Aziz Abdullah, Syed Farhan Ahmed, Muhammad Rashid, Waqas Ahmed

Department of Urology, Liaquat National Hospital, Karachi, Pakistan

E-mail: [email protected]

Objective: The aim of our study was to assess the efficacy and experience of gracilis muscle interposition for complex rectourethral fistula (RUF).

Study Design: Study was conducted as inpatients at Department of Urology, Liaquat National Hospital, Karachi.

Duration of study: From Jan 2016 to March 2018.

Background: Rectourethral fistula is a rare but challenging outcome of firearm injuries/blast injuries. A variety of procedures have been described to treat this condition, none of which has gained acceptance as the procedure of choice. The aim of this study was to review the authors' experience with gracilis muscle interposition in the treatment of rectourethral fistula.

Subject and Methods: All in-patients who fulfilled the inclusion criteria in the Department of Urology, Liaquat National Hospital, Karachi were included in the study. After taking informed written consent, history, clinical examination and proper investigation; patients were planned for rectourethral fistula repair with interposition of gracilis flap. A retrospective chart review of all patients who underwent gracilis muscle interposition for rectourethral fistula was made, and follow-up was established on OPD basis. Successful repair was defined as absence of a fistula after reversal of fecal and urinary diversions.

Results: A total of 11 patients were included in our study. All were males and had FAI (Fire Arm Injuries). All FAI cases had Exploratory Laparotomy + Bladder repair. 2 patients had Diversion Ileostomy. Initial presentation was urine per rectum. All cases were confirmed by cystouretherogram. Cystoscopy was done in all cases before definitive surgery. RUF repair with interposition of Gracilis flap was performed. 8 out of 11 patients' surgeries went uneventful. 2 had infected wound which required secondary suturing. 1 had urinary leakage from wound which required redo surgery.

Conclusion: Gracilis muscle interposition is an effective surgical treatment for rectourethral fistula after FAI. It is associated with low morbidity and a high success rate.

   Five-years follow-up of tension-free vaginal tape versus rectus sheath sling for surgical treatment of female stress urinary incontinence Top

E. Safwat, Abou Hashem Mohamed Mustafa, Wael Elbrombely1

Departments of Urology and1Gynecology, Zagazig University Egypt and King Abdulaziz Specialized Hospital, El Taef, Saudi Arabia

E-mail: [email protected]

Objective: This study was undertaken to compare long-term outcome of Tension-Free Vaginal tape (TVT) with Rectus Sheath Sling as the primary treatment for stress urinary incontinence.

Patients and Methods: Perioperative complications, and hospital stay were prospectively recorded. Cure of SUI was defined as no leakage of urine during the stress test and at urodynamic testing. Patients were followed up for 5 years, 48 complete evaluations and 8 lost during follow up.

Results: The mean operative time was significantly shorter in the TVT group. Perioperative complications, intraoperative blood loss,hospital stays, and time to return to normal activities were insignificantly differing between both groups. Forty-Eight patients out of 56 patients (84.2%) were successfully followed up for 5 years after the operation with success (88.5% and 84.6% for TVT and ectus sheath sling groups, respectively.

Conclusion: TVT and rectus sheath sling appear to be equally effective in the surgical treatment of SUI. However, TVT had insignificantly a shorter operative time hospital stays, and time to return to normal activities than rectus sheath sling ,TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications.

   Malignancy after kidney transplantation; Tabuk experience Top

M. Elbahnasawy, H. Yehia, A. Alali, A. Elbahnassawi1, A. Albalawi, Y. Osman

Department of Surgery, Urology Division, King Salman Armed Forces Hospital,1Department of Nephrology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

E-mail: [email protected]

Introduction and Objectives: In kidney transplant recipients, the incidence of cancer is generally increased 2 to 4 fold compared with the general population. Nonmelanoma skin cancer is the most common malignancy, followed by post-transplant lympho-proliferative disorder and solid organ tumors. Immunosuppression plays a central role in pathogenesis in addition to other transplant-related and traditional risk factors as viral infections. Urinary and kidney malignancies may be linked to ESRD. Malignancies are diagnosed at younger age and at higher stages compared to patients without transplantation, and are associated with worse outcomes.Our objective is to retrospectively analyze the prevalence of malignancy among cases of kidney transplant in our hospital.

Materials and Methods: In this retrospective study,385 cases of renal transplantation (RT) who has follow up in our renal and transplantation unit , were analyzed depending on database from 2000 to 2018. Patients records were reviewed for the duration of pre-RT hemodialysis, type of kidney donor (cadaveric or live donor-related or unrelated), immunosuppression protocol, post transplantation time until developing malignancy, type of diagnosed malignancy and management of each malignancy.

Results: During the study period a total of 9 cases (2.34%) of post-RT malignancy has been diagnosed Mean age at diagnosis was 53.6 years while mean post-transplantation duration before malignancy was 10.5 years. Two cases received unrelated kidney donors, one cadaveric kidney, and one had second kidney transplant. Skin cancer was seen in 4 cases, while genitourinary malignancy was diagnosed in 3 cases(one seminoma ,one muscle invasive bladder cancer and one graft RCC) and 2 cases developped thyroid carcinoma. Two cases ( 22.2%) died of malignancy including a case of advanced graft renal cell carcinoma (RCC), who died of inoperable malignancy.

Conclusions: The risk of developing post renal transplantation malignancy is higher than normal population. Skin cancers are the more prevalent malignancy. Lympho-proliferative malignancies were not seen in our RTR. Patients receiving kidneys of unrelated donor, cadaver, or re-transplant are at higher risk, possibly due to more aggressive immunosuppressive protocols. Aggressive behavior of these malignancies highlights the necessity of long life follow up, putting a high index of malignancy suspicion for early diagnosis. Modification of immunosuppressive protocol is advised in such malignant cases.

   Locally advanced rectal cancer infiltrating lower urinart tract; role of urologist Top

Magdy S. EL-Bahnasawy, Feras Alahmad, Mohamed, Abdelfatah, Yazeed Alghabban, Ahmed Kamal

King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

E-mail: [email protected]

Introduction: Between 5% and 10% of patients with rectal cancer present with locally advanced rectal cancer (LARC). Exenterative multivisceral resection offers the best long-term outcomes for patients with LARC so long as a complete (R0) resection is achieved. Potential operability of advanced rectal tumors, and resectability may be enhanced with neoadjuvant therapies. Role of urologist in such total exenterative surgery is crucial for proper evaluation of degree of involvement of the lower urinary tract ,intra-operative adequate completion of the resection and for establishment of successful urinary diversion. In selected cases, trial of bladder and prostate preservation could be tried successfully.

Materials and Methods: Herein we present a case of LARC invading the prostate in a 62 years old patient. Neoadjuvant chemo-radiotherapy significantly downstaged the rectal tumor but recto-prostatic invasion persisted with fistula formation. Pelvic MRI proved infiltration of the prostate with obliteration of the prostate-rectal plane. Urethro-cystoscopy documented presence of prostate-rectal fistula with hemorrhagic cystitis. Posterior pelvic exentration was completed by the onco-surgeon while the anterior part involving the bladder and prostate being accomplished by the urologist. Frozen section from apex of prostate was free of malignancy. Ileal loop conduit was performed. Final histopathology confirmed RO resection with moderately differentiated rectal carcinoma infiltrating the prostate.

Conclusion: Multidisciplinary approach helped to cure LARC. Collaborative intra-operative work ensures safe complete surgical resection. Role of urologist is integral for proper of decision of lower urinary tract resectability or presevation and type of urinary diversion.

   Brucellosis epididymo-orchitis; prevalence in an endemic area, diagnosis and management Top

M. Elbahnasawy, T. Alzahrani, M. Alanazi, A. Alhowidi, A. Alali, F. Ismail, A. Albalawi

Department of Surgery, Urology Division, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

Introduction and Objectives: Epididymo-orchitis is a focal form of human brucellosis with an incidence of 2-20% in patients with brucellosis. However patients rarely present to the clinicians with acute scrotum due to Brucellosis Epididymo-Orchitis (BEO) as an initial finding. Our aim is to estimate the prevalence of the BEO among the cases diagnosed with Epididymo orchitis in our hospital over the last five years.

We describe the clinical characteristics, treatment, and final outcomes of cases of brucellosis presented initially as Epididymo orchitis in an endemic area.

Materials and Methods: This retrospective study involved all cases diagnosed with Epididymo-orchitis(EO) in our hospital from 2015 through 2019. A total of 103 cases of Epididymo-orchitis were diagnosed during this period. All cases presented to ER with epididymo-orchitis were subjected to full clinical and laboratory evaluation including Brucella serologic test for both B abortus and B melitensis(a titer of 1:80 or greater is often considered clinically significant). None of these cases had previous history of Brucellosis. Scrotal Doppler ultrasonographic examination was requested at initial diagnosis and after 2 weeks to exclude abscess formation.

Results: Out of 103 cases, 17 were diagnosed to have brucellosis (16.5%). The mean age of patients of Brucellosis Epididymo-orchitis (BEO) was 30.9 years (range, 16 -42 years) .All patients had positive history of consuming unpasteurized dairy products. The mean age of patients of non-BEO was 36.04 years (range,5-85years).The age difference was highly significant between both groups. The diagnosis of brucellosis was made via positive serological testing results(Brucella abortus and melitensis ). Ultrasonography findings were hyper vascularity of testis and Epididymis, with heterogeneous texture and reactive hydrocele . One case showed testicular abscess formation.

All cases were given combination of tetracycline and rifampicin for 6-12 weeks.

Two cases required prolonged hospital stay due to testicular abscess formation in one and development of Brucellosis spondylitis in the other. Gentamycin was added for one week in such cases.

Conclusions: Brucellosis is significantly prevalent among our patients presented with EO. BEO must be considered in the differential diagnosis of acute scrotum in endemic regions The diagnosis is easy by positive serology tests. Positive cases need special antibiotic combination protocol for longer time and close monitoring for development of local complications or other systemic brucellosis manifestations.

   Nonoccupational squamous cell carcinoma of the scrotum; case presentation and management Top

Magdy S. EL-Bahnasawy, Mshari Alanazi, Talahmeh Ghasan, Ibrahim Mosaad, Anas Abolhasan, Mohamed Johani, Ahmed Kamal

Introduction: Although the incidence of scrotal malignancies is extremely low Squamous cell carcinoma (SCC) is the most common scrotal malignancy. Its overall annual incidence is approximately 1.5 per 1,000,000 persons in Western countries. It was first linked to the chronic irritation of scrotal skin by the effect of soot in occurring in chimney sweepers hence known as the first described occupational disease. Occupational scrotal SCC was also later described in association with other occupations with chronic carcinogen exposure including cotton mule spinners, paraffin and tar workers, creosote workers, shale oil workers, lathe workers, pitch workers and machine tool setters and operators. Currently most cases result from poor hygiene and chronic inflammation.

Materials and Methods: This 55 years old male patient was referred from dermatology department. He had no underlying occupational hazard. He has been treated for several months of itchy inflammation of the scrotumfor 6 months. Scrotal punch biosy showed moderately differentiated SCC. Clinically there was malignant scrotal ulcer of 4x3 cm with no palpable inguinal lymph nodes. CT staging confirmed localized tumor with no LN or metastatic deposits.

Complete excision with 2 cm safety margin confirmed to be negative by frozen section. Final histopathology come to be moderately differentiated SCC pT2Nx. All margins and underlying Dartos were free of tumor infiltration.

Conclusion: Although rare, Scrotal SCC continues to be seriuos urogenital malignancy which should be suspected even in the absence of occupational exposure. Cooperation and awareness of Dermatologists is important for early detection and management of such rare malignancy. Complete excision with safety margin is usually sufficient for cure. Inguinal Lymphadenectomy is indicated if grossly infiltrated.

   Epitheliod renal angiomyolipoma with renal vein tumor thrombus Top

Magdy EL-Bahnasawy, Mohamed Abdel-Fatah, Wajdi Alwazni, Anas Abolhasan, Abdulaziz Alhowidi, Laila Moharram

Introduction: Renal Angiomyolipomas (AMLs) are generally considered benign tumors however Epitheliod variant with cellular atypia may have malignant potential.

Methods: A twenty nine years lady presented with accidentally discovered right renal mass during abdominal US for follow up of hepatitis. CT scan with contrast showed central right renal mass4x4x4.5 cm with evidence of tumor thrombus extension into main renal vein. Right radical nephrectomy was carried out with proximal securing of renal vein at the level of Vena Caval ostium. Histopathology showed Cellular Angiomyolipoma with atypia. Patient was free of any evidence of recurrence or metastasis after 3 years of follow up.

Conclusion: EAML are tumors with malignant potential and these patients need rigorous follow up by CT abdomen and chest after 6 months then yearly for 5 years. The presence of ≥70% atypia,necrosis,atypical mitotic figures are indicative of malignant behavior of EAMLs.


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