bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study between the Effect of Intravenous versus Intrathecal Dexamethasone on Post Dural Puncture Headache in Cesarean Section Surgeries
Authors: Abdelaleem Azaa Atef , Elgendy Hanaa Abdallah , Abelghafour Mohamed Ahmed Saudy , Shahat Mohamed Asmaa Mohamed
Published: November 2024

Background

One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for decreasing incidence of post operative side effect like PDPH.

Objective

To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone in the prevention of post dural puncture headache in spinal anesthesia in cesarean section surgeries.

Patients and Methods

We performed our study on 75 patients divided into 3groups (control group, IT group, IV group) respectively the first group25 patients had classic spinal, the second group 25 patients had classic spinal and 2ml (8mg) dexamethasone intravenously and the third group had spinal anesthesia with 0.5ml (2mg) dexamethasone intrathecally. All patients observed for 48hrs for occurrence of headache (PDPH) after excluded other types of headache. The incidence, severity, onset and duration of the headache assessed.

Results

The results revealed that there was significantly difference between the groups in incidence, Severity, onset and duration of PDPH. There was a statistically significant higher frequency of headache in control group was 10 patients (40%), followed by IV group was 7 patients (28%), then IT group was 3 patients (12%). As well as a statistically significant higher frequency of severe headache in control group, while there is no severe headache in IT group and IV group,). The results shows a statistically significant higher mean value of duration “hrs.” of headache in control group was 22.29±11.87, followed by IV group and IT group was (12.00±0.00 and 12.86±8.07) respectively.

Conclusion

This study showed that use of dexamethasone decrease the incidence and duration of PDPH. As There was a statistically significant higher frequency of headache in control group, followed by IV group then IT group. As well as a statistically significant higher frequency of severe headache in control group, while there was no severe headache in IT group and IV group, The results showed that duration of headache in control group was higher, followed by IV group and IT group respectively.
Ultrasound Guided Ilioinguinal/Iliohypogastric Nerve Block versus Transversus Abdominis Plane Block in Pain Management Following Unilateral Inguinal Hernia Repair
Authors: Mohamed Elsebaiee Basel Magdy , Din Abdel Hamid Amr Essam El , Mohamed El Fawal Sanaa Mohamed , Mahmoud Bayoumy Aya Ali
Published: November 2024

Background

Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia and prolonged hospital stay.

Aim of the Work

The aim of this study was to assess the postoperative analgesic efficacy of TAP block compared to IIN+IHN nerves block after unilateral inguinal hernia repair regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.

Patients and Methods

The study was conducted on 64 randomly chosen patients American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups.

Results

The study revealed that patients received IIN+IHN block had significantly lower pain scores after operation, delayed time for rescue analgesia and decreased total need of analgesic in the first 24hrs post- operative compared to patients who received TAP nerves block.

Conclusion

IIN+IHN block was effective in reducing postoperative pain scores, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to TAP nerves block.
Intranasal Dexmedetomidine versus Intranasal Ketamine as Pre-Anaesthetic Medication in Paediatric Age Group Undergoing Surgery
Authors: Mohammed Dalia Abd El-hamid , Ghaly Safaa Ishak , Mohammad Douaa Galal , Diaa El-din Doaa Ahmed
Published: November 2024

Background

The immediate pre-operative period is a very stressful time for most of the individuals undergoing surgery especially the paediatric patients. So, relieving their pre- operative anxiety becomes an important concern for an anaesthesiologist. Many anaesthetic pre-medications are used to relieve this stress response. Of these pre-medications, ketamine and dexmedetomidine are effectively used as sedatives. The present study is planned to compare sedative effect of intranasal dexmedetomidine vs intranasal ketamine as a pre- anaesthetic medication in children.

Aim of the Work

To compare the sedative effects, successful child–parental separation and haemodynamic parameters of intranasal dexmedetomidine versus ketamine as a premedication in children undergoing surgery.

Patients and Methods

After Ethical Committee approval and written informed parents’ consent, this Prospective randomized controlled clinical trial was performed in Ain Shams University Hospitals, Cairo, Egypt. Ninety children were scheduled to undergo elective surgeries.

Results

ninety children, aged between 2-8 years of either sex, belonging to ASA I-II, scheduled for elective surgery were enrolled in this prospective, randomized and comparative clinical study. The children were divided into two groups of 45 each. thirty minutes before induction, Group-D (n = 45) received intranasal Dexmedetomidine 1mcg/kg and Group K (n = 45) received intranasal ketamine 2mg/kg. Our study showed that there was no statistically significant difference between the two groups as regarding the HR and the blood pressure at 10 and 20 min after intranasal drug instillation. There was a statistically significant decrease in the dexmedetomidine group regarding the heart rate and the BP at 30 min, preoperative and during the intraoperative period. There was no significant difference in oxygen saturation between both groups. The MOAA/S scores were comparable in both groups, It was significantly lower in the ketamine group at 10 and 20 min after the administration of the drug. However, at 30min there was a statistically significant decrease in sedation score in the D group compared with group K.

Conclusion

Revealed that both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and slight delay in onset of sedation, and there was little decrease in heart rate and MAP which is favorable during surgeries. Also, there was accepted parental separation scores denoting that there was smooth and easy separation from guardians. Thus, it can be concluded that intranasal dexmedetomidine can be used effectively and safely as a preanesthetic medication in children undergoing any surgical procedures under general anesthesia.
Ultrasound Measurement of Optic Nerve Sheath Diameter as Non-Invasive Detector of Raised Intracranial Pressure in Adult Traumatic and Non-Traumatic Neurocritical Patients in ICU
Authors: Abdelaziz Mohammed S , Abd Elmegid Khaled M , Tawadros Safaa I , Ahmed Ibrahim M , Elmalakhany Kareem E
Published: November 2024

Background

Measurement of intracranial pressure (ICP) is crucial in the management of many neurological conditions. However, due to the invasiveness, high cost, and required expertise of available ICP monitoring techniques, many patients who could benefit from ICP monitoring do not receive it. As a result, there has been a substantial effort to explore and develop novel non-invasive ICP monitoring techniques to improve the overall clinical care of patients who may be suffering from ICP disorders.

Objective

Assessment of the role of ultrasound as a non-invasive method (bedside) to measure the raising of intracranial pressure by measuring the optic nerve sheath diameter in traumatic and nontraumatic neurocritical patients.

Patients

and Methods: A total of 100 patients of both sexes above 18 years old diagnosed with traumatic & non-traumatic brain injury with high intracranial pressure (ICP) which suspected by the initial CT brain and Marshall Classification were enrolled. Patients were divided into control group that included 50 patients with no evidence of any intracranial abnormality or severe head injury. Mean ONSD in the control group was considered to be normal. Study group subjects included 50 patients aged above 18 years old who sustained a severe traumatic or non-traumatic brain injury (GCS <8) All patients had a non-contrast CT head b efore any surgical or non-surgical i ntervention. The CT head was used to determine the Marshall score.

Results

Optic nerve sheath diameter was statistically significant higher in all periods 0-24 hours among cases with high intracranial tension compared with control ones with statistically significant positive correlations between it and age at 6hrs. and 24hrs and Marshal score at Ohr. and 24hrs and negative correlation between it and GCS score at Ohr. and 24hrs. The best cut off value for detector of raised intracranial pressure was 4.9 with sensitivity 94.7%, specificity 83.3%, positive predictive value 94.7% and negative predictive value 83.3%.

Conclusion

The evaluation of the optic nerve sheath diameter is a simple non-invasive procedure, which is a potentially useful tool in the assessment and monitoring of traumatic and nontraumatic neurocritical patients suspected of having raised intracranial pressure.
Atropine Prophylaxis before Spinal Anesthesia in Young and Middle Age Males Undergoing Inguinal Hernia Repair
Authors: Abdelrahman Mohamed Mahmoud Mohamed , Mahmoud El- Azazi Hesham Mohamed , El sayed Abdellatif Ayman Ahmed , Fawaz Mariam Momtaz
Published: November 2024

Background

Spinal Anesthesia is a common type of anesthesia used during many surgical procedures. This regional technique can be accomplished by administering an intrathecal dose of hyperbaric local anesthetic solution. The local anesthetic within the subarachnoid space can block sensory, motor and sympathetic pathways. One of the most common complications associated with spinal anesthesia is hypotension with or without bradycardia that can increase risk of perioperative cerebral and cardiovascular events.

Aim of the Work

to find out the effectiveness of prophylactic administration of intravenous atropine for attenuation of spinal anesthesia induced hypotension in inguinal hernia repair surgeries.

Patients and Methods

Therefore, A randomized controlled clinical trial was found to be the most suitable design in order to achieve the study objectives. A total of 40 patients males included in the study, aged 15-60 years, and were divided equally into two groups: Group 1 received intravenous injection of 0.01 mg /kg atropine sulphate one minute before spinal anesthesia and fluid preloading 500 ml Ringer solution. Group 2 received the same volume of normal saline intravenous bolus.

Results

Prophylactic intravenous atropine sulphate 0.01 mg /kg intravenous one minute prior to spinal anesthesia in inguinal hernia repair surgeries was effective in reducing spinal anesthesia induced hypotension, incidence of hypotension was lower in atropine exposed group compared to placebo group. The incidence of ephedrine use and number of boluses of fluids were lower in atropine exposed group compared to placebo group.

Conclusion

among patients who received spinal anesthesia with bupivacaine for elective inguinal hernia repair, prophylactic intravenous atropine sulphate 0.01 mg /kg prior to spinal anesthesia reduced spinal anesthesia induced hypotension and reduced ephedrine use.
A Comparative Study between C-MAC Video-Laryngoscope and Fiberoptic Laryngoscope in Anticipated Difficult Intubation
Authors: Salama Nahed Effat Yousef , Abdelatif Ayman Ahmed El-Sayed , Soliman Madkour Mohamed Emad , Toulan Heba F
Published: November 2024

Background

Numerous indirect laryngoscopes have been introduced into clinical practice and compared with the Macintosh laryngoscope. Most studies have described a significantly better glottic view and a higher success rate in difficult tracheal intubations for the indirect laryngoscopes. Some case reports also describe the successful use of these tools under sedation with preserved spontaneous breathing.

Objective

To compare the C-MAC® D-Blade video laryngoscope and the flexible fiberoptic scope for intubation of patients with anticipated difficult intubation. The primary endpoint was the time to achieve successful tracheal intubation. Secondary endpoints included glottic view at intubation and the number of intubation attempts. The study was conducted on 60 patients at the operating theatres of Ain Shams University Hospitals.

Patients and Methods

After obtaining approval from the Research Ethical Committee, Faculty of Medicine, Ain Shams University and informed consents from patients, 60 American Society of Anaesthesiologists I-II adult patients with El-Ganzouri risk index score (EGRI) ≥ 4 (age range, 21- 60 years) undergoing elective surgeries requiring tracheal intubation were enrolled in this prospective study at the operating theaters of Ain Shams University Hospitals from March 2022 to October 2022.

Results

Our results showed Duration of intubation (s) among the study groups. Duration of intubation (s) in Video laryngoscope Group ranged from 22 to 34 seconds with mean ± SD = 27.87 ± 3.74 while in Fiberoptic Group the Duration of intubation (s) ranged from 60 to 75 seconds with mean ± SD = 66.77 ± 4.24 with highly statistically significant difference (p = <.001) between the two groups and showed POGO score among the study groups. Regarding POGO score, there was a significant difference between the two studied groups (p = 0.019). C-MAC video laryngoscope had become a good alternative and was associated with visualization of laryngeal structures in shorter time as compared to traditional flexible fiberoptic laryngoscopy.

Conclusion

This randomized, prospective study demonstrated that the C-MAC may offer an advantage over the fiberoptic laryngoscope with respect to the time required to obtain a clear glottic view and successful placement of the tracheal tube. However, the Flexible Fiberoptic Scope offered a better visualization of the glottic opening compared to the C-MAC video laryngoscope. The use of C-MAC as a usual tool was limited as it is expensive device, and the use of fiberoptic bronchoscope needs more experience and training.
Comparative Study between Preoperative Nebulization with Magnesium Sulfate and Ketamine in the Prevention of Postoperative Sore Throat during General Anesthesia with Endotracheal Intubation in Adults, a Randomized Double Blinded Clinical Trial
Authors: Mohamed Ahmed Mohamed Rizk , Moustafa Zakaria Abdelaziz , Kamal Karim Youssef , Salah Asmaa Mohamed
Published: November 2024

Background

Post operative sore throat (POST) is a common complication following general anesthesia requiring endotracheal intubation with incidence ranges from 21% to 65%, also it may consider a minor complication, but if left unresolved, it produces significant agony and annoyance to the patients, if it was severe, it may be associated with hoarseness of voice or change of voice.

Aim of the Work

In our study we compare between ketamine nebulization and magnesium sulphate nebulization to evaluate their efficacy in decreasing incidence and severity of POST and concluding which drug is better.

Patients and Methods

This study is a randomized double blinded clinical trial, after obtaining approval from the research ethical committee of Faculty of Medicine, Ain Shams University, this study was conducted in the operating theaters of Ain Shams University Maternity Hospital. Patients were randomly allocated by computer generated randomization into two groups (M, K) each group 20 patients: group Magnesium (M): patients received preoperative nebulization with 250 mg magnesium sulfate in 5ml saline, group Ketamine (K): patients received preoperative nebulization with 50 mg ketamine in 5ml saline.

Results

The result of the study showed that preoperative nebulization with ketamine 50mg is more effective than preoperative nebulization with magnesium sulfate 250mg in reducing incidence and severity of post operative sore throat especially early after operation.

Conclusion

We conclude that preoperative nebulization with ketamine 50mg is more effective than preoperative nebulization with magnesium sulfate 250mg in reducing incidence and severity of post operative sore throat especially early after operation.
Preoperative versus Postoperative Ultrasound-Guided Quadratus Lumborum Block for Postoperative Analgesia Following Radical Nephrectomy, A Comparative Study
Authors: Mohammad Ahmad Elewa Gamal Eldin , Maamoon Rania Maher Hussien , Wasfy Sanaa Farag Mahmoud , Abdelraouf Younis Mohammed Mahmoud
Published: November 2024

Background

The QLB is an effective analgesic technique for various abdominal wall incisions. The QLB covers T7 to L1 dermatomes by the spread of LA drugs either into the paravertebral space or in the thoracolumbar plane, through iliohypogastric and ilioinguinal nerves, A and C fiber nociceptors, mechanoreceptors and high-density network of lumbar sympathetic fibers.

Objective

To compare the effectiveness of ultrasound-guided preoperative to postoperative QLB on the effectiveness and duration of postoperative analgesia represented as time of first analgesia requested by patients.

Patients and Methods

After approval of research ethical committee of Ain Shams University Hospitals, this prospective double blinded randomized clinical study was conducted between April 2023 till September 2023, written consent was taken from all participants after explaining the procedure. One hundred and eight patients were included. later on. eight patient were excluded due to bleeding, failed block, duration of surgery more than 180 minutes. Included patients were divided into 2 groups 50 each.

Results

The current study also calculated and compared the standard deviation for each of the two groups analyzed, as well as the postoperative NRS score, initial time to rescue analgesia, and total amount of opioids (Nalbuphine) administered in the first 24 h. When compared to the postoperative QLB group (Group B), preoperative QLB patients (Group A) showed higher values. Postoperative QLB was found to be more effective than preoperative QLB in this clinical trial. Group B was found to be superior to Group A in terms of analgesia (Nalbuphine), total Nalbuphine consumption, and NRS score. Group A had higher pain ratings and were the first to rescue analgesia. There are no many studies were done comparing preoperative versus postoperative plan block especially with QLB in postoperative pain management and that’s the gab of knowledge in our study.

Conclusion

Postoperative administration of QLB in nephrectomy provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to preoperative administration of QLB.
Ultrasound-Guided Quadratus Lumborum Block Using Bupivacaine versus Bupivacaine–Magnesium Sulfate as Postoperative Analgesia in Open Appendectomy in Middle Age Group
Authors: Elshafie Mohamed Anwar , Ammar Mona Ahmed Mohamed , Hamid Yasmine Magdy Abdel , Mohammed Mostafa Aly Abdelrahman
Published: November 2024

Background

The QLB is an effective analgesic technique for various abdominal wall incisions. The QLB covers T7 to L1 dermatomes by the spread of LA drugs either into the paravertebral space or in the thoracolumbar plane, through iliohypogastric and ilioinguinal nerves, A and C fiber nociceptors, mechanoreceptors and high-density network of lumbar sympathetic fibers.

Objective

To assess the analgesic sparing effect of adding magnesium sulfate to Bupivacaine in Quadratus lumborum block in patients undergoing open appendectomy under general anesthesia.

Patients and Methods

After approval of the anaesthesiology department and scientific and ethical committees, this prospective single blind randomized clinical trial study was conducted in Ain Shams University Hospitals. Sixty patients scheduled for open appendectomy under general anaesthesia were included in this study. Patients were randomized using a random number table and the use of a closed envelopes technique to receive quadratus lumborum either magnesium sulphate and bupivacaine or bupivacaine only, each group constitutes of 30 patients.

Results

We found that the addition of magnesium sulfate to bupivacaine in QLB in open appendectomy in middle age group provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to bupivacaine alone group.

Conclusion

The addition of magnesium sulfate to Bupivacaine in lateral QLB in open appendectomy surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to bupivacaine alone group.
Comparative Study between Dexmedetomidine and Fentanyl as Adjuvants to Bupivacaine for Prevention of Post Spinal Shivering in Caesarean Sections
Authors: Kamal Abdel-Shafy Noura Abdel-Monem , Sedky Abdel- Rahman Kareem Ahmed , Saleh Zaki Gamal Fouad , Farag Awad Hanan M
Published: November 2024

Background

Shivering is a common complication in regional anesthesia during cesarean sections. It can impair monitoring and increase oxygen demand, CO2 production, and wound pain, healing, and discharge. Spinal anesthesia can increase vulnerability to hypothermia, leading to shivering. Dexmedetomidine and fentanyl have been shown to prevent post-spinal shivering.

Aim of the Work

This study aimed to compare the efficacy and safety of fentanyl and dexmedetomidine in preventing perioperative shivering and their effects on block intensity, hemodynamics, sedation, postoperative pain, and analgesic requirement.

Patients and Methods

150 obstetric patients were included and randomized into three equal groups: control, fentanyl, and dexmedetomidine group. Each group received 12.5 mg hyperbaric bupivacaine 0.5% intrathecally with different adjuvants.

Results

Both fentanyl and dexmedetomidine groups showed a decreased incidence and intensity of shivering compared to the control group. There was no statistically significant difference between the two groups in this regard (p-value >0.05). The onset and duration of sensory and motor block were faster and prolonged in both fentanyl and dexmedetomidine groups compared to the control group, but dexmedetomidine showed faster onset and more prolonged duration than fentanyl. Dexmedetomidine also showed a statistically significant difference regarding hypotension (p-value <0.05) but non-significant regarding bradycardia (p-value >0.05) compared to other groups. There were no statistically significant differences in sedation intensity between the groups (p-value >0.05). Fentanyl showed a higher incidence of nausea, vomiting, and pruritis compared to other study groups.

Conclusion

Both fentanyl and dexmedetomidine are safe to use with bupivacaine for prevention of perioperative shivering in cesarean sections. Both drugs decreased the incidence and intensity of shivering, and dexmedetomidine was more effective in terms of prolongation of sensory and motor block duration and reducing opioid requirements. Dexmedetomidine showed fewer side effects during the intra and postoperative period compared to fentanyl.
A Comparative Study between the Efficacy of Ultrasound Guided Erector Spinae versus Quadratus Lumborum Plane Blocks in Laparoscopic Appendectomy
Authors: Omran Yomna Abdelrahim , Maghawry Khaled Mohamed , Ismail Wafaa Elsayed , Shohdy Haidi Nashaat
Published: November 2024

Background

Laparoscopic appendectomy is more superior to open appendectomy in terms of wound site infections and pain intensity. Although the laparoscopic technique is minimally invasive, postoperative pain is inevitable, and it may affect the patients’ mobility and cause them to stay in the hospital for a more extended period.

Aim of the Work

to compare the effectiveness of erector spinae plane block and quadratus lumborum plane block as part of multimodal analgesia for reducing postoperative pain in patients undergoing laparoscopic appendectomy.

Patients and Methods

This prospective randomized controlled clinical trial was conducted at operative theatres, Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University Hospitals from April until September 2023.

Results

During this study, 54 patients undergoing laparoscopic appendectomy were enrolled and divided into two equal groups; group A subjected to erector spinae block and group B subjected to quadratus lumborum block. Intraoperative, Post Anaesthesia Care Unit and postoperative haemodynamic, postoperative NRS score, first time of postoperative analgesic request, total amount of postoperative analgesia and serum cortisol levels were measured. In this study there was a significant difference between the two groups regarding NRS scores and total amount of analgesia needed post operatively. In this study, no statistically significant difference was observed between the two groups in terms of serum cortisol levels. In this study, no significant difference was found between the two groups regarding heart rate and mean arterial pressure.

Conclusion

Both QLB and ESPB are effective as post-operative analgesia techniques for laparoscopic appendectomy. However, our study showed that US-guided ESPB may provide better pain control than QLB. These results allows healthcare providers and patients to choose the most suitable technique based on individual preferences and clinical considerations. However, further research with larger sample sizes and multicentric studies would be valuable to confirm these findings and explore potential variations in different patient populations or surgical settings.
The Effect of Tadalafil 5 mg on Outflow Obstruction due to Benign Prostatic Hyperplasia
Authors: Ghareeb Mohammed Esmat Abo , Azzazy Samir Sayed Mohammed , El-Labban Ahmed El-Husseiny Mohammed
Published: November 2024

Background

Tadalafil showed efficacy in treatment of LUTS due to BPH. In several clinical studies, it was found to have different mechanisms of actions on prostate through increasing blood supply and oxygenation, decreasing intrprostatic inflammation and relaxation of smooth muscle fibers.

Objective

to assess the effect of tadalafil on uroflowmetry and IPSS in patients with BPH/LUTS.

Patients and Methods

This study is prospective, non-randomized; single-arm study that was conducted on patients obtained from outpatient urology clinics of Ain Shams University Hospital & El-Sahel Teaching Hospital in the study period between September 2021 and May 2022. It was conducted on 55 patients with BPH/LUTS who received tadalafil 5 mg daily, IPSS was assessed before starting treatment and after 12 weeks, Uroflowmtery was done before starting treatment, after 4 weeks and 12 weeks of treatment.

Results

Our study showed that Qmax increased from baseline 10.8±2.0 to 11.5±2.4 in week-4, then to 12.7±2.2 in week-12. The change from baseline to week-4 was 0.6±0.5, the elevation was statistically significant (p < 0.001). The change from baseline to week-12 was 1.9±0.3, the elevation was statistically significant (p < 0.001). The change from week-4 to week-12 was 1.3±0.4, the elevation was statistically significant (p < 0.001).

Conclusion

In patients with BPH/ LUTS, tadalafil 5 mg once daily resulted in statistically significant improvement in IPSS and Qmax and it was well tolerated.
The Efficacy and Safety of Adjunctive Alpha-Blocker Therapy before Flexible Ureteroscopy in the Management of Upper Ureteric Stones in Pediatrics Group
Authors: Abo Ghareeb Mohamed Esmat , Mohamed Mohamed Hasan , Ibrahim Ahmed Hamdy
Published: November 2024

Background

The incidence of pediatric urolithiasis has risen dramatically over the past few decades, with a reported rate of 4% per year. A unique aspect of children is the smaller ureteral diameter, which often results in failure to access the ureter during an initial URS (either Flexible or Rigid) attempt to be able to perform the intended procedure.

Aim of the Work

To evaluate efficacy adjunctive alpha-blocker therapy before Flexible ureteroscopy in the management of Upper ureteric stones (ranging from 5:10 mm) in children as regard facilitating ureteric orifice navigation and ureteral dilatation.

Patients and Methods

This was a prospective randomized control study that was conducted at Urology Department, Faculty of Medicine, Ain Shams University on 80 patients they were divided into 2 groups. Group A (random): 40 Children received Tamsulosin 0.4 mg capsule for 5 days prior to Flexible ureteroscopy. Group B (random): 40 Children didn’t receive Tamsulosin 0.4 mg capsule prior to Flexible ureteroscopy.

Results

There were 60 child were male and 20 were female and their ages ranged from 5 to 18 years (mean 10.66 years). There was no statistically significant difference between Group A and Group B regarding age (Years), gender, Body mass index (kg/m2) and Side. Successful stone access occurred in 34 of 40 patients (85%) who had received tamsulosin and 30 of 40 (75%) who had not (p = 0.264). There was no statistically significant difference between Group A and Group B regarding stone burden (mm2), successful access and stone free rate. There was no statistically significant difference between Group A and Group B regarding complication (P < 0.05).

Conclusion

Adjunctive alpha-blocker therapy (Tamsulosin) before flexible ureteroscopy in the management of upper ureteric stone in school age children failed to show a statistically significant difference for successful ureteral orifice navigation, ureteral dilatation, stone free rete and complication.
Predictive Value of E-Cadherin, β-Catenin and SOX4 in Recurrence and/or Progression of Non-Muscle Invasive Urinary Bladder Transitional Cell Carcinoma. A Retrospective Study
Authors: Safaan Ahmed Mohamed , Amin Aly Roshdy Mamdouh Mohamed , El-lithy Tarek Ramzy , Alsaid Mohamed Hassan , Hammam Olfat Ali Ibrahim , Mohamed Mousa Ahmed Kadry Salama
Published: November 2024

Background

Bladder cancer (BC) is one of the most common genitourinary cancers worldwide, the pathophysiology and etiology of BC are complicated, including both internal genetic and environmental factors. Currently, some studies suggest that the abnormal function of intercellular adhesion molecules is highly correlated with the invasion of surrounding tissues and distant organ metastasis of BC.

Objective

To develop a correlation between these markers and NMIBC and to help predict the recurrence and/or progression.

Patients and Methods

It is a retrospective cohort (observational) study assessing a correlation regarding the alternation in the expression of E-cadherin, β-catenin and SOX4 in determining the recurrence and/or progression and their prognostic value in NMIBC TCC. Patients Diagnosed with NMIBC TCC and their follow ups data were evaluated at the urology department in Theodor Bilharz Research Institute (TBRI) and Ain Shams University from January 2019 – till July 2022.

Results

Loss of normal expression of E-cadherin and β-catenin, upregulation of SOX4 is significantly correlated with BC and tumorigenesis, yet no clear relation between E-cadherin, β- catenin and SOX4 in progression or recurrence of NMIBC, regarding It’s staining intensity, percentage of positive cells and immunoreactive score (IRS).

Conclusion

bases on our current study, E-cadherin, β-catenin and SOX4 showed highly significance difference between normal urothelium and TCC NMIBC indicating it may have a role in diagnosis, although its value changes with follow up of the patients but of non-significant difference to predict prognosis, recurrence and/or progression among TCC NMIBC.
Effect of Preoperative Silodosin on Ureteric Dilatation in Retrograde Intrarenal Surgery
Authors: Radwan Ahmed Ibrahim , Ghani Ahmed Ramadan Mohamed Abdel , Gamil Ahmed Maher
Published: November 2024

Background

Selective alpha blockers have been used for treatment for ureteric stones as medical expulsive therapy (MET). Recently they have been successfully used in passive ureteric dilatation before semirigid ureteroscopy.

Objective

This study enables us to know the role of silodosin in ureteric dilatation to facilitate ureteral access sheath placement in Retrograde Intrarenal Surgery (RIRS) with flexible ureteroscopy (F-URS).

Patients and Methods

A total of 120 patients with renal or upper ureteric stone of 2 cm or less were enrolled, after consenting each of them and divided into two groups; group A (study group) that included 60 patients who underwent flexible ureteroscopy using Ho-YAG laser for stone disintegration. These patients received silodosin ‘one tablet 8 mg per day’ for three days preoperatively and group B (control group) included 60 patients who underwent non-stent ureteroscopy using Ho- YAG laser for stone disintegration. These patients received placebo for three days. All patients were blind to the medication received. Our primary outcome was to assess success of ureteric access sheath placement as follows: spontaneous passage of ureteral access sheath without dilatation or passage of UAS after dilatation or failure of the ureteral access sheath insertion. All cases were classified accordingly.

Results

Successful placement and spontaneous uretroscopy passage without dilatation were statistically significant higher with less frequency of failed dilatation in silodosin group. Also, operative time, frequency of stone residual, hospital stay and total cost were statistically significant lower. Finally, postoperative complications as pain, hematuria and mucosal injuries were statistically significant lower.

Conclusion

Preoperative use of silodosin increases the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures.
Comparison between Flexible Ureteroscopy by Using Uretral Access Sheath and Flexible Ureterosopy without Using Ureteral Access Sheath in Cases of Upper Ureteric and Pelvic Stones
Authors: ahmed Hussein Ibraheem , Shaker Hassan Sayed , El-Moazen Mohamed Ibrahim
Published: November 2024

Background

Ureteral access sheath use has been widely accepted by urologists since older ureteroscopes were difficult to insert into the ureter due to their stiffness, width and limited deflection angles. However, with advancing technology and design improvement, new generation ureteroscopes are thinner and built with lighter and more flexible materials than their older counterparts. This in turn has produced devices that are easier to maneuver, meaning that procedures can be performed without needing UAS thus the actual benefit of UAS was under question.

Aim of the Work

to compare the usage of UAS versus not using the UAS during FURS regard operative time, intra operative, postoperative complications and patient satisfaction.

Patients and Methods

This randomized controlled clinical trial was conducted in Urology Department, Ain Shams, University Hospitals and included 50 upper ureteric stone disease patients. They were divided into 2 comparative groups (each group 25 patients) by closed envelop method. One of these groups underwent FURS with ureteral access sheath and the second group underwent FURS without ureteral access sheath.

Results

there was no significant difference between the 2 groups regarding demographic or clinical data. Moreover, no significant difference was detected between the 2 groups regarding intra or post-operative complications, stone free rate or duration of hospital stay. However, statistically significant longer operative time was recorded in UAS group compared to no UAS group.

Conclusion

our study showed that flexible ureterenoscopy without ureteral access sheath Seems to be safe as flexible ureterenoscopy with ureteral access sheath regards intraoperative, post- operative complications, patient satisfaction, stone free rate and duration of hospital stay, an additional advantage is shorter operative time without using of ureteral access sheath
Efficacy and Safety of Submucosal Intravesical Injection of Platelet-Rich Plasma in the Treatment of Interstitial Cystitis/Painful Bladder Syndrome
Authors: Saleh Ismail Mahdy , Mourad Mohamed Sherif , Hassan Ahmed Tawfik , Ramsis Samir Younan
Published: November 2024

Background

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition predominantly affecting women, characterized by urinary symptoms and pelvic pain. Diagnosis entails exclusion and the presence of symptoms for 6 weeks to 6 months. Various treatments, including intravesical therapies like platelet-rich plasma (PRP) injections, aim to improve bladder function and quality of life by addressing symptom severity and recurrence.

Aim of the Work

To assess the effectiveness of submucosal intravesical injection of autologous platelet-rich plasma in the treatment of IC/PBS resistant to conventional methods of treatment.

Patients and Methods

This is a one-arm clinical trial conducted at Ain Shams University hospitals in Cairo, Egypt, from April 1, 2021, to April 1, 2023, involving 30 Egyptian patients aged 30-50 with interstitial cystitis/bladder pain syndrome (IC/BPS). Patients undergo preoperative assessments, receive 20 submucosal injections of platelet-rich plasma (PRP) solution, and are followed up postoperatively. The treatment outcome is evaluated using the Global Response Assessment (GRA) scale at 6 months.

Results

The study demonstrates significant improvements in multiple parameters post- treatment with platelet-rich plasma (PRP) for Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS). Reductions were observed in ICSI, ICPI, OSS, VAS for pain, frequency, nocturia, and FBC after 1, 3, and 6 months compared to baseline, all with p-values < 0.001. Additionally, postoperative complications, notably hematuria and UTI, significantly decreased. The GRA at 6 months showed a 63.3% success rate. Significant differences between improvement and failure groups were noted in multiple parameters, supporting PRP's efficacy in managing IC/PBS resistant to conventional therapies.

Conclusion

The study demonstrates that submucosal intravesical injection of autologous platelet-rich plasma (PRP) offers a promising treatment option for IC/PBS patients resistant to conventional therapies, with a 63.3% success rate and significant symptom improvement, suggesting PRP's potential in urothelial regeneration. Further research is warranted.
Incidence of Pathological Types of Urinary Bladder Tumors Diagnosed at Ain Shams University Hospitals
Authors: Ragy Shereen Ibrahim , Fekry Elshorbagy Ahmed Amr , Halim Ibrahim Mariam Ibrahim , Mortagy Yassa Kyrillos Naguib
Published: November 2024

Background

Bladder cancers are the most common genitourinary malignancy in both males and females. They are broadly categorized as urothelial and non-urothelial tumors. The response to treatment and the overall survival among the cases with cancer bladder depend greatly on the pathological type of the tumors.

Objective

Detection of the incidence of different pathological types of bladder tumors diagnosed at Ain Shams University Hospitals.

Patients and Methods

This retrospective study was conducted by reviewing the medical records of patients admitted and treated for urinary bladder cancer along five years duration from January 2017 to December 2021. We applied our study on 1000 patients.

Results

TCC was the most common type among our cases 945 (94.5%) followed by SCC 1.5%, adenocarcinoma 1.0% and others (3.0%). As regard lymph nodes, metastasis and type of treatment, our study revealed that they were negative or couldn't be detected in 90% of cases that proved that the majority of urinary bladder tumors are usually localized with less liability of spread so most of cases (74%) treated by follow up cystoscopy with less need for radical cystectomy or chemo-radiotherapy. However, most of the SCC cases were positive lymph nodes (66.7%) with positive metastasis (66.7%) and required radical cystectomy. Most of tumors were located in posterior and posterolateral (right and left) parts of the urinary bladder. Bladder tumors were more frequent in age group of 57.34 ± 15.08 years with male predominance (86.0%).

Conclusion

Screening of bladder tumors should be scheduled for high risk cases.
Transurethral Diode Laser Ablation of Prostate Vs Bipolar Transurethral Vaporization of Prostate, A Prospective Randomized Controlled Study
Authors: Salim Mohamed S , Hegazy Ahmed Salah Eldin , Rashed Mostafa Mohammad Mohammad Ebraheem , Elnagar Ashraf Elsayed , Mahmoud Mahmoud Saeed , Abuelnaga Mohamed
Published: November 2024

Background

Vaporization/Ablation of prostate is becoming one of the standard modalities for treating of symptomatic cases of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) especially in men with bleeding tendency.

Objective

to compare the short term safety and efficacy of bipolar plasma versus laser ablation of prostate and follow up over 6 months post operative.

Patients and Methods

This prospective randomized control study (double armed) included 60 patients with prostates less than 80 gm operated upon and followed up in the Urology Department of Ain Shams University hospitals. The patients were divided into 2 groups: Group A 30 Patients underwent Transurethral Diode Laser Ablation, Group B 30 Patients underwent Bipolar Transurethral Vaporization as the control group.

Results

When we compared both groups of patients there was no great difference and both techniques proved great efficiency and safety on patients especially in high risk group of patients, and both of them resulted in improvement in all parameters of LUTS secondary to BPH (decrease of IPSS, increase of Q max, decrease of residual urine and PSA). There was no risk or major complication encountered in the study e.g. no significant bleeding and no risk of TUR syndrome. However operation time was shorter in laser group 22 (mean) min compared to 49 min in bipolar group. Also the mean cost of laser group was about 30000 EGP and the mean cost of bipolar group was 20000 EGP in Ain Shams University hospital. Also catheter time was shorter in laser prostatectomy 24 hours versus 48 hours in bipolar, this is done in trial to lessen the irritative effect of vaporization on the nerve ending, and avoid the expected dysuria.

Conclusion

Both techniques are considered safe and effective, similar in the outcome and both techniques has excellent hemostatic profile with no serious complications occurred in both groups. Laser is a faster technique than bipolar however it's more expensive.
Intralesional Injection of Mitomycin C Following Visual Internal Urethrotomy for Recurrent Urethral Stricture
Authors: mostafa Diaaeldin , higazy Ahmed , Mohammed Mostafa Lotfy , Salim Mohamed S
Published: November 2024

Background

Urethral stricture is one of the oldest known urologic diseases with high recurrence rate. It is defined as narrowing of the urethral lumen caused by scarring. Injuries to the urethral epithelium or the underlying corpus spongiosum may lead to scar formation which causes narrowing of the urethral lumen leading to urethral stricture and spongiofibrosis which can lead to total replacement of the spongy tissue by scar tissue.

Aim of the Work

To asses the efficacy of Intralesional injection of mitomycin C following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture.

Patients and Methods

This is prospective randomized interventional study carried on 50 male patients with recurrent bulbar urethral stricture of < 1.5 cm. They were randomised to undergo either VIU only (Group-A) or VIU with MMC injections (Group-B). The urethrotomy was performed under direct vision using a cold-knife and incisions were made at the 12-, 3-, and 9- o’clock positions followed by intralesional injection of 10 mL MMC (0.4 mg/mL) using Botox injection needle. All patients were objectively evaluated pre- and postoperatively at 3 and 6 months using uroflowmetry (maximum urinary flow rate), post-void residual urine volume, and retrograde urethrography.

Results

Of all 50 patients; five missed follow-up (three in Group-A, two in Group-B), therefore 45 cases were available for analysis (22 in Group-A and 23 in Group-B). The mean (SD) age of patients was 32.0 (8.1) and 34.0 (6.2) years in Group-A and Group-B, respectively (P = 0.314). The most common cause of a urethral stricture in both groups was iatrogenic injury. Regarding stricture recurrence, there was significant decrease in Group-B (four patients, 17.4%) compared with Group- A; (ten patients, 45.5%) (P = 0.042). This study demonstrated that visual internal urethrotomy for recurrent urethral stricture with intralesional injection of 10 mL mitomycin C MMC (0.4mg/mL) decreases the recurrence rate of the urethral stricture.

Conclusion

Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture seems to be a safe and effective modality of treatment in reducing the incidence of recurrent stricture after VIU.
The Efficacy of Silver Nanoparticles (Tetrasilver Tetroxide) in Treatment of Diabetc Foot Ulcer
Authors: Soliman Abdelbary Mostafa , Rizk Mohamed Abdelmonem , Mahmoud Amr Abdelghaffar , Mohamed Hossam Abdelaziz
Published: November 2024

Background

Uncontrolled diabetes contributes to the development of neuropathy and peripheral arterial disease by complex metabolic pathways. Loss of sensation caused by peripheral neuropathy, ischemia due to peripheral arterial disease, or a combination of these may lead to foot ulcers.

Aim of the Work

The aim of this work is to know the efficacy of the tetra silver tetroxide (silver nanoparticles) in treatment of diabetic foot ulcer. the primary endpoint is limb salvage. the secondary endpoint is wound healing, time of wound healing and number of days of dressings.

Patients and Methods

This is a prospective randomized cohort study that was conducted on 40 patients presented with DFU between 1st of January 2021to 1st of January 2022 at Ain Shams University Hospitals and Nasser institute Hospital.

Results

This study included 40 patients presented with DFU 20 Patients were treated with conventional dressing.and the other 20 Patients were treated using silver nanopartcles dressing (tetrasilver tetroxide spray and gel.) There was no statistically significant difference between the two groups regarding the number of cases with complete healing (P = 0.064). There was highly statistically significant difference between the two groups regarding time of complete healing by weeks (P = 0.000) and number of days of dressing (P = 0.000). There was statistically significant difference between the two groups regarding the infection which is more in group b (P = 0.035). There was no statistically significant difference between the two groups regarding limb salvage(P = 0.136), minor amputation (P = 0.064) major amputation(P = 0.136) and mortality

Conclusion

Nano silver dressings are superior to convetional dressings regarding secondary end point (infection and time for complete wound healing and number of days of dressings) and non superior in primary endpoint (limb salvage).