Aboulela, W., M. S. Elsheemy, A. I. Shoukry, A. M. Shouman, A. ElShenoufy, K. Daw, H. A. Morsi, and H. Badawy, "Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience.", Journal of endourology, vol. 29, issue 6, pp. 661-5, 2015 Jun. Abstract

PURPOSE: To evaluate prospectively safety and efficacy of transurethral cystolithotripsy (CL) in children using holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This is important in developing countries, because the risk of bladder stones in children is high. Open cystolithotomy (OC) was the main line of treatment. A gradual shift has occurred toward endourologic treatment after improvement of pediatric endoscopes.

PATIENTS AND METHODS: Between January 2010 and May 2011, 33 children <12 years old with vesical calculi were treated. Children with orthopedic deformities, urethral stricture, history of urethral operations or bladder reconstruction, or stones >4 cm were excluded. Cystoscopies were performed under general anesthesia using 9 to 11F cystoscopes. Stones were completely fragmented under video guidance. Ho:YAG was applied at a power of 30 W.

RESULTS: Median age was 3 years (0.5-11). Mean stone size was 2.02±0.82 cm (1-4 cm). Mean operative duration was 31.21 minutes (20-50). All children were discharged within 24 hours. A single operative session was performed for each patient. No complications were detected. After a mean follow-up of 16.87±4.08 months, all children were stone free, without development of any urethral stricture or recurrence of stones. Operative duration was significantly longer in stones >20 mm (P<0.001).

CONCLUSION: Ho:YAG laser CL is a safe and successful minimally invasive treatment option for bladder stones in children. Success rate was 100% without development of any complications or recurrence.

Daw, K., A. M. Shouman, M. S. Elsheemy, A. I. Shoukry, W. Aboulela, H. A. Morsi, H. Badawy, and M. A. Eissa, "Outcome of Mini-percutaneous Nephrolithotomy for Renal Stones in Infants and Preschool Children: A Prospective Study.", Urology, vol. 86, issue 5, pp. 1019-26, 2015 Nov. Abstract

OBJECTIVE: To assess the safety and efficacy of Miniperc for renal stones in preschool-age patients. To the best of our knowledge, this may be the first prospective study on this subject. Reports on Miniperc are still few and mostly retrospective using a sheath size of ≥ 18Fr, which is still relatively large for young children.

PATIENTS AND METHODS: From January 2012 to May 2013, Miniperc was performed for 26 children (≤ 6 years old) with renal calculi <5 cm through 14Fr sheath using a 9.5Fr semirigid ureteroscope with Holmium:yttrium-aluminum-garnet laser lithotripsy. Effects of different factors on operative time, complications, and stone-free rate (SFR) were compared using chi-square, Fischer exact, or Mann-Whitney tests as appropriate using SPSS v15.0.

RESULTS: Primary SFR, SFR after retreatment, and SFR after auxiliary extracorporeal shock wave lithotripsy (ESWL) were 77%, 85%, and 92%, respectively. Retreatment rate was 8%. Auxiliary ESWL was done in 11%. Complications were bleeding (8%), hematuria and blood transfusion (4%), renal pelvis perforation (4%), leakage (8%), and fever (15%). Operative time was significantly prolonged in multiple (>2) stones (P = .006), calyceal stones (P = .002), or stone size ≥ 30 mm (P = .022). SFR was significantly lower in children with >2 stones (P = .028) and increased stone size ≥ 30 mm (P = .014).

CONCLUSION: Miniperc is a safe and effective minimally invasive procedure for pediatric renal stones using 14Fr access sheath. SFR was significantly lower in children with >2 stones or increased stone size ≥ 30 mm. This was overcome by retreatment and auxiliary ESWL.

Elsheemy, M. S., K. Daw, E. Habib, W. Aboulela, H. Fathy, A. M. Shouman, M. ElGhoneimy, A. I. Shoukry, H. A. Morsi, and H. Badawy, "Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.", International journal of urology : official journal of the Japanese Urological Association, vol. 23, issue 7, pp. 564-70, 2016 07. Abstract

OBJECTIVES: To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children.

METHODS: From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test.

RESULTS: Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively.

CONCLUSIONS: The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.

Alsharnoubi, J., A. A. Sabbour, A. I. Shoukry, and A. M. Abdelazeem, "Nocturnal enuresis in children between laser acupuncture and medical treatment: a comparative study.", Lasers in medical science, vol. 32, issue 1, pp. 95-99, 2017 Jan. Abstract

Nocturnal enuresis (NE) is intermittent involuntary voiding during sleep in a child aged 5 years or more. The study was conducted to compare the effect of using laser acupuncture and medication for the treatment of children with nocturnal enuresis (NE) and evaluation of urodynamic parameter after treatment. A randomized study included 45 children ranged from 5 to 15 years presenting with NE. They were randomized into three equal groups-group A, managed with desmopressin acetate; group B, managed with laser acupuncture; and group C, managed with a combination of laser acupuncture and desmopressin-all groups received behavioral therapy. The children were evaluated before and after 3 months of the study to record the efficacy of therapy, side effects and bladder capacity, and 3 months of follow-up after cessation of treatment by bladder diary. A statistically significant higher cure rate was reported in group B patients (73.3 %), while in groups A and C, improvement was reported in 20.0 and 13.3 %, respectively (p value = 0.002). Laser acupuncture is noninvasive, painless tool, with no side effects and lower recurrence rate which can be considered as an alternative therapy for patients with NE.

Elsheemy, M. S., W. Ghoneima, M. Abdelwahhab, W. Aboulela, K. Daw, A. M. Shouman, A. I. Shoukry, M. ElGhoneimy, H. A. Morsi, and H. Badawy, "The role of voiding cystourethrography in asymptomatic unilateral isolated ureteropelvic junction obstruction: A retrospective study.", Journal of pediatric urology, vol. 13, issue 2, pp. 206.e1-206.e7, 2017 Apr. Abstract

INTRODUCTION: The presence of concomitant vesicoureteric reflux (VUR) and ureteropelvic junction obstruction (UPJO) is uncommon. Nevertheless, the reported VUR coexisting with asymptomatic unilateral isolated hydronephrosis (AUIH) requiring pyeloplasty for correction of UPJO was of low grade and mostly resolved during conservative follow-up. Therefore, VCUG may be not indicated in these children except if voiding symptoms, urinary tract infection (UTI), dilated ureters, or bladder and ureteric abnormalities are suspected.

OBJECTIVES: The aim was to evaluate the need for VCUG in infants <1 year old with AUIH for whom a dismembered pyeloplasty was indicated for correction of UPJO.

METHODS: Ninety-six children <1 year old with pyeloplasty carried out from January 2012 to March 2014 were retrospectively included. Children with voiding symptoms or dilated ureter, duplex system, fused kidneys, bilateral dilatation, or any bladder abnormality on ultrasound were excluded. Anderson-Hynes pyeloplasty was performed through a flank incision. Preoperative VCUG was analyzed in relation to outcome and any UTI during follow-up. The Student t test, Mann-Whitney U test, or Fisher exact test were used to compare variables.

RESULTS: Five children had concomitant VUR with UPJO. Most of the children were circumcised during the first postnatal week. The remaining few children were circumcised at the time of pyeloplasty. Side, grade of detected VUR, and complications (18.75%) (postoperative or during follow-up) are presented in the Table. Outcomes in children with and without VUR were not different. Dismembered pyeloplasty was successful in children with VUR and with no complications except for non-febrile UTI in one child only. Ureters were still not dilated at the last follow-up.

DISCUSSION: The required imaging in infants with AUIH is still a subject of debate. As we expected, there was a low incidence of associated VUR in the present study. They were of low grade without any complications during follow-up and without affecting the outcome. The present study has its limitations, including the retrospective nature and short follow-up. However, as at least 2 years of follow-up were documented without any harm or ureteric dilation, VUR will mostly resolve. The present study is strengthened by inclusion of infants only.

CONCLUSIONS: Our data suggest that VCUG is not indicated in infants with AUIH requiring pyeloplasty for correction of UPJO. VCUG will not affect the treatment decision, operative outcome, or postoperative complications. VCUG may be indicated in case of suspected voiding symptoms, UTI, dilated ureters, or bladder and ureteric abnormalities.

Aboulela, W., M. S. Elsheemy, M. Shoukry, A. M. Shouman, A. I. Shoukry, W. Ghoneima, M. ElGhoneimy, H. A. Morsi, M. A. Mohsen, and H. Badawy, "Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife.", International urology and nephrology, vol. 50, issue 4, pp. 605-609, 2018 Apr. Abstract

PURPOSE: To compare efficacy and safety of visual internal urethrotomy (VIU) using holmium laser (Ho:YAG) (group A) versus cold knife (group B) in children with urethral strictures. It may be the first comparative study on this issue in children.

METHODS: This study compared Ho:YAG group, which was evaluated prospectively from January 2014 till January 2016, versus cold knife group, which was a historical control performed from March 2008 till February 2010. Children ≤ 13 years old with urethral strictures ≤ 1.5 cm were included successively. Recurrent cases, congenital obstructions and cases with complete arrest of dye in voiding cystourethrography were excluded. Scar tissue was incised at twelve o'clock. Outcome was compared using Student's t, Mann-Whitney, Chi-square or Fisher exact tests as appropriate.

RESULTS: Each group included 21 patients. Mean age was 6.27 ± 3.23 (2-13) years old. Mean stricture length was 1.02 versus 1 cm in group A versus B, respectively (p = 0.862). Ten cases of penile/bulbous strictures and another 11 cases of membranous strictures were found in each group. There was no significant difference between both groups in preoperative data. Success rate for initial VIU was 66.7% in group A versus 38% in group B (p = 0.064). This was associated with significantly higher Q in group A (mean 16.52 vs 12.09 ml/s; p = 0.03). Success rate after two trials of VIU was 76.2% for group A and 47.61% for group B (p = 0.057). No complications were reported in both groups.

CONCLUSION: Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Q. Both are easy to perform, low invasive and safe.

Soaida, S. M., M. S. Elsheemy, A. M. Shouman, A. I. Shoukry, H. A. Morsi, D. M. Salah, F. I. Fadel, and H. M. Bazaraa, "Caudal extradural catheterization in pediatric renal transplant and its effect on perioperative hemodynamics and pain scoring: a prospective randomized study", Journal of anesthesia: Springer Japan, pp. 1–8, 2015. Abstract
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Daw, K., A. M. Shouman, M. S. Elsheemy, A. I. Shoukry, W. Aboulela, H. A. Morsi, H. Badawy, and M. A. Eissa, "Outcome of Mini-percutaneous Nephrolithotomy for Renal Stones in Infants and Preschool Children: A Prospective Study", Urology, vol. 86, no. 5: Elsevier, pp. 1019–1026, 2015. Abstract
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Shoukry, A. I., W. N. Abouela, M. S. Elsheemy, A. M. Shouman, K. Daw, A. A. Hussein, H. Morsi, M. A. Mohsen, H. Badawy, and M. Eissa, "Use of holmium laser for urethral strictures in pediatrics: A prospective study", Journal of pediatric urology: Elsevier, 2015. Abstract
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Aboulela, W., M. S. Elsheemy, A. I. Shoukry, A. M. Shouman, A. ElShenoufy, K. Daw, H. A. Morsi, and H. Badawy, "Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience", Journal of Endourology: Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA, 2015. Abstract
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