Marawan El Tayeb M.D.

Thai, K.H., Smith, J.C., Stutz, J., Sung, J., Shaver, C. and El Tayeb, M. (2020). “Urethral complications while using 26-French versus 28-French resectoscope sheaths in Holmium Laser Enucleation of the Prostate: A Retrospective Observational Study.” J Endourol Sep 1. [Epub ahead of print.].

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OBJECTIVE: To determine the rate of the urethral stricture (US) and bladder neck contracture (BNC) between patients who undergo Holmium Laser Enucleation of Prostate (HoLEP) surgery with 26Fr vs. 28Fr resectoscope sheaths (RS). Studies report rates of 2.8-4.4% and 3.6-5.4% for US and BNC, respectively. To date, there are no studies that have shown the difference between resectoscope sheath size and urethral complications. METHODS: We retrospectively reviewed charts of patients who had HoLEP surgery between August 2015 to June 2018, by a single surgeon. Prior history of US or BNC were excluded. The operative set-up for a HoLEP includes Ho:YAG laser, urethral dilation, a 26Fr or 28Fr continuous flow RS, and a tissue morcellator. Primary endpoints include postoperative US or BNC. Secondary endpoints include postoperative catheterization time, success of voiding trial and urinary incontinence. Statistical analysis was performed using appropriate methods. RESULTS: Out of 502 HoLEP patients, 339 consecutive patients had surgery with 28Fr RS (Group A) and 163 consecutive patients had surgery with a 26Fr RS (Group B). Twelve patients (A) and three patients (B) had post-op US (p=0.41). Eight (A) and zero (B) patients had post-op BNC (p=0.0585). SUI at 6 weeks, 3-6 months, and 1 year, was present in 15.9% (both A & B), 6.5% (A) vs 6.1% (B) (p=0.88), and 3.2% (A) vs 1.8% (B) (p=0.564), respectively. Both blood loss and change in hemoglobin were higher in 28Fr group with no significant difference in rate of transfusion. Conclusions Resectoscope sheath size had no impact on the rate of US or BNC, however lower incidence in the 26Fr sheath cohort for both. 28Fr sheath had larger change in hemoglobin levels and estimated blood loss, but the higher rate of transfusion was not statistically significant. No difference in the stress incontinence rates, length of stay, and enucleation rates.

Spitler, C. A., E. R. Row, W. E. Gardner, 2nd, R. E. Swafford, M. J. Hankins, P. J. Nowotarski and D. W. Kiner (2019). “Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial.” J Orthop Trauma 33(8): 371-376.

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OBJECTIVE: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. DESIGN: Prospective, randomized controlled trial. SETTING: Single Level 1 trauma center. PATIENTS: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. INTERVENTION: The study group received 15 mg/kg IV TXA before incision and a second identical dose 3 hours after the initial dose. MAIN OUTCOME MEASUREMENTS: Transfusion rates and total blood loss (TBL) [via hemoglobin-dilution method and rates of venous thromboembolic events (VTEs)]. RESULTS: TBL was significantly higher in the control group (TXA = 952 mL, no TXA = 1325 mL, P = 0.028). The total transfusion rates between the TXA and control groups were not significantly different (TXA 1.51, no TXA = 1.17, P = 0.41). There were no significant differences between the TXA and control groups in inpatient VTE events (P = 0.57). CONCLUSION: The use of TXA in high-energy fractures of the pelvis, acetabulum, and femur significantly decreased calculated TBL but did not decrease overall transfusion rates. TXA did not increase the rate of VTE. Further study is warranted before making broad recommendations for the use of TXA in these fractures. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Bhojani, N., J. E. Paonessa, M. M. El Tayeb, J. C. Williams, Jr., T. A. Hameed and J. E. Lingeman (2018). “Sensitivity of Noncontrast Computed Tomography for Small Renal Calculi With Endoscopy as the Gold Standard.” Urology 117: 36-40.

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OBJECTIVE: To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray, ultrasound, and noncontrast CT. Sensitivities of 58%-62% (abdominal x-ray), 45% (ultrasound), and 95%-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. METHODS: Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy were studied. At the time of surgery, the number and the location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro-CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. RESULTS: Eighteen renal units were studied in 11 patients. Average time from CT scan to ureteroscopy was 28.6 days. The mean number of calculi identified per kidney was 9.2 +/- 6.1 for endoscopy and 5.9 +/- 4.1 for CT (P <.004). The mean size of total renal calculi (sum of the longest stone diameters) per kidney was 22.4 +/- 17.1 mm and 18.2 +/- 13.2 mm for endoscopy and CT, respectively (P = .06). CONCLUSION: CT scan underreports the number of renal calculi, probably missing some small stones and being unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared with that found on endoscopic examination.