Hamid Ghazali - Academia.edu (original) (raw)

Papers by Hamid Ghazali

BJU International, 2018

Introduction and Objective: Tenckhoff catheter (TC) insertion for continuous ambulatory peritonea... more Introduction and Objective: Tenckhoff catheter (TC) insertion for continuous ambulatory peritoneal dialysis (CAPD) can be done using various methods such as percutaneously, open method or laparoscopically. The two most common complications are catheter migration and obstruction, which are surgically correctable. The aim of this study is to determine the outcome of laparoscopic approach to TC salvage. Material and Methods: Patients who underwent TC insertion either by open method or percutaneously between February 2016 and Jun 2018 were reviewed retrospectively for primary failure, which needed laparoscopic revision. We studied the causes of malfunction, laparoscopic surgical techniques and its outcome. Results: 149 TC were inserted. The total incidence of primary failure of TC was 25 (16.7%). The causes of TC malfunction were blocked catheter in 21 patients (84%) and migrated catheter in four patients (16%). The mean age of patients who underwent revision surgery was 40.9 (SD: 15.01) years old and the mean BMI was 23.7 (SD: 3.63). The mean primary latency was 6.9 (SD: 9.03) months. There were three reported secondary failures where the patients converted to hemodialysis post operatively; one was due adhesion and another two were due to peritonitis. At median follow up duration of 10 months, 23 (88%) TC maintains patency while 3 (22%) secondary failure was reported in two patients due to peritonitis and severe intraperitoneal adhesions respectively. Survival of TC after laparoscopic revision was analysed using Kaplan Meier curve indicates that 88% of TCs were able to maintain patency at 12 and 24 months. Conclusion: Laparoscopic TC salvage is a worthwhile endeavor to prolong patency for CAPD.

Turkish journal of urology, Apr 7, 2022

Objective: Degloving perineal injury is defined as avulsion of the perineal skin and subcutaneous... more Objective: Degloving perineal injury is defined as avulsion of the perineal skin and subcutaneous tissue from its surrounding fascia, bone, and organs. This injury is most commonly caused by road vehicle accidents or alleged falls from heights. This devastating injury is associated with high morbidity and mortality if mismanaged. We retrospectively evaluated our management protocol for degloving perineal injury and the clinical outcomes of our case series. Material and Methods: Six cases of open perineal degloving injuries were managed and retrospectively reviewed at our center from 2018 to 2020, comprising 2 cases of isolated degloving wounds of the scrotum and 4 cases of complex perineal injuries associated with pelvic fracture, anorectal injuries, or complete transacted urethral injuries. Two of the 6 patients had open-book pelvic fractures that required pelvic stabilization. Results: Complex degloving perineal injuries can be managed through (1) resuscitation and pelvic packing; (2) urgent life-threatening treatments; (3) pelvic exploration with debridement; and (4) primary repair of anorectal or transacted urethral injuries with external pelvic fixation. All patients promptly underwent surgical repair after immediate diagnosis and resuscitation. Additionally, patients were operated by specialized teams according to the proposed management approach as shown in Figure 1. All patients recovered well and had good functional outcomes. Conclusion: A multidisciplinary team comprising general surgeons, urologists, orthopedic surgeons, and plastic surgeons was involved in this review. Prompt diagnosis and immediate surgical intervention remain the standard requirements for complex degloving perineal injuries. We proposed a management protocol that is safe for managing complex perineal injuries.

Introduction: Changes in voiding positionmay have signi ficant impact on micturitiondue to factors... more Introduction: Changes in voiding positionmay have signi ficant impact on micturitiondue to factors such as changes in pressureof abdominal muscles and viscera, andrelaxation of pelvic floor muscles in differ-ent voiding positions. Few studies in the lit-erature have addressed the impact ofvoiding position on uroflowmetric results,however, the results were inconclusive.Objectives: To investigate the uroflowme-try findings of three different voiding posi-tions in BPO patients attending theUrology Clinic, HTAA.Materials and Methods: Cross-sectionalobservational study of BPO patientsattending the Urology Clinic HTAA fromMarch 2015 to December 2015.Uroflowmetry in standing, sitting andsquatting positions were done in those ful-filling the study criteria. The maximumflow rate, average flow rate, voiding vol-ume, total voiding time and post-voidingresidual volume were measured andrecorded. The results were then comparedand analysed. Other factors such as nor-mal voiding habit, number of medication,...

Introduction Glans penis gangrene is a rare condition that carries special challenges in managing... more Introduction Glans penis gangrene is a rare condition that carries special challenges in managing the problem. It is usually associated with vascular insufficiency and amputation is required to prevent spread of infection from the necrotic tissue. While most penile gangrene presented on top of Fournier's gangrene, this particular case presented with isolated glans penis gangrene. Case Report A 60 year-old man, known case of diabetes mellitus, presented with lethargy and poor oral intake for past 1 month. He denied having any prior urinary symptoms, external device applications or trauma. He was treated as having hyperosmolar hyperglycemic state. At catheterization there was blackish discoloration over the glans penis with erythema of surrounding penile shaft. Foley catheter was successfully inserted. His blood investigations were suggestive of infection and acute renal injury secondary to dehydration. Urine analysis was clear of infection. Parenteral Ampicillin and Metronidazole...

Institut Terjemahan & Buku Malaysia & Universiti Islam Antarabangsa Malaysia, 2018

Inverted papilloma of the urinary bladder is rare. In the paediatric group, this condition is eve... more Inverted papilloma of the urinary bladder is rare. In the paediatric group, this condition is even more rare. To date only five cases have been reported in the English literature. Due to its rarity, the morphology and biological behaviour are still uncertain. We report a case of inverted papilloma of the urinary bladder in a 12-year-old girl who presented with recurrent haematuria. The patient’s symptoms resolved after endoscopic resection with no recurrence on cystoscopy surveillance for last two years. The magnetic resonance imaging features of this lesion are described.

Introduction & Objective: Incidence of urolithiasis is high in our country. Treatment modalities ... more Introduction & Objective: Incidence of urolithiasis is high in our country. Treatment modalities vary depending to the size and location of stone and patient's fitness for invasive treatment. Identifying the most suitable treatment modalities according to patient's clinical characteristic is important to get optimum stone clearance with least complication and better cost-benefit. General Objectives 1. To prove that primary RIRS is more effective than ESWL in treatment of renal stone with suspected failure of ESWL Specific objectives 1. To show that RIRS has better stone clearance in treatment of renal stone with suspected failure of ESWL 2. To show that RIRS is more cost effective in treatment of renal stone with suspected failure of ESWL 3. To identify factors that favors RIRS than ESWL in treatment of renal stone with suspected failure of ESWL Materials and Methods: This is a randomized controlled trial done for a period of two years from from August 2014 to July 2016 in H...

Urinary bladder stone affected humankind since antiquity. It disease was noted in Egyptian manusc... more Urinary bladder stone affected humankind since antiquity. It disease was noted in Egyptian manuscript more than 3500 BC. Along the history it management also evolve from perineum extraction to endoscopic management. Recent review article on urinary bladder stone management suggested percutaneous stone management for stone between 2-4cm sizes.

Journal of Men's Health, 2011

Urinary bladder diverticulum tumour is rare. It has been estimated that only 2.6% of all bladder ... more Urinary bladder diverticulum tumour is rare. It has been estimated that only 2.6% of all bladder diverticulum develop malignancy and most were diagnosed late. Delay in diagnosis can be due to presence of intra-diverticular stone which can compress and hide any evidence of mucosal changes. We report the case of a 53-year-old man who presented with multiple lower urinary tract stone including in the urethra, bladder and bladder diverticulum. Serial investigations before a diagnosis of a bladder diverticulum adenocarcinoma were made. The tumour was hidden behind a stone.

Malaysian Journal of Medical Sciences

Background: Penile augmentation using injection of a foreign body into penile skin was mainly per... more Background: Penile augmentation using injection of a foreign body into penile skin was mainly performed by non-medical personnel. Majority of these patients end up with complication of an abnormal mass formation known as penile paraffinoma. Methods: We described three different surgical techniques for correction of penile paraffinoma based on our single-centre experience. Informed consents were obtained from patients whose photographs were taken during the operation step. Results: In general, three patients had simple excision biopsy with primary suturing, four patients underwent single stage excision of circumferential granuloma with bilateral scrotal skin flap reconstruction and one patient experienced dual stage procedure. Three of them were injected with paraffin, one with silicone and the remaining four were unable to identify the substance used. All patients successfully underwent the surgical procedure and four of them had minor postoperative surgical site infection and wound gapping. Conclusion: All patients recovered well and the mean International Index of Erectile Function (IIEF-5) score obtained was 24.25. In our experience, excision biopsy was adequate for focal mass and reconstructive surgery using bilateral scrotal flap was suitable for circumferential mass.

African Journal of Urology, 2021

Background To describe our scrotal bridge flap technique in reconstructive surgery for extensive ... more Background To describe our scrotal bridge flap technique in reconstructive surgery for extensive penile paraffinoma, a debilitating late complication of penile subcutaneous foreign material injection intended to achieve penile augmentation. Case presentation We reviewed the medical records of 10 patients who underwent reconstructive surgery with the scrotal bridge flap technique for penile paraffinoma at our center between 2016 and 2019. Complete excision of fibrotic tissue and the overlying skin was performed, and penile resurfacing was achieved by mobilizing the scrotal skin superiorly to wrap around the penile shaft, leaving a skin bridge at the median raphe. All 10 patients successfully underwent scrotal bridge flap penile reconstruction with satisfying results. The mean operation duration was 286.1 min (range 213–363 min). No immediate major complications were observed in any of the patients, and no patients required revision surgery. Conclusion The scrotal bridge flap techniqu...

Malaysian Family Physician

Background: A penile median raphe cyst is an uncommon congenital lesion that is formed due to fai... more Background: A penile median raphe cyst is an uncommon congenital lesion that is formed due to failure of the median raphe to close completely during embryo development. The majority of the cysts are asymptomatic and often go unnoticed. Here, we report acute urinary retention as a very rare complication of a penile median raphe cyst. Case presentation: A 21-year-old single man presented with a sudden onset of acute urinary retention of one days’ duration. Urethral catheterization was done at the Emergency Department and this drained 800 ml of urine. On further questioning, he claimed that he had had a painless nodule at the glans penis since childhood. The swelling increased in size in the past week causing discomfort. He denied any history of genitalia trauma or recent sexual intercourse. On examination, there was a bluish lesion over the ventral aspect of the glans penis measuring about 3 x 2 cm. The lesion was later excised and histopathology revealed a median raphe cyst of the pe...

BJU International, 2018

Introduction and Objective: Tenckhoff catheter (TC) insertion for continuous ambulatory peritonea... more Introduction and Objective: Tenckhoff catheter (TC) insertion for continuous ambulatory peritoneal dialysis (CAPD) can be done using various methods such as percutaneously, open method or laparoscopically. The two most common complications are catheter migration and obstruction, which are surgically correctable. The aim of this study is to determine the outcome of laparoscopic approach to TC salvage. Material and Methods: Patients who underwent TC insertion either by open method or percutaneously between February 2016 and Jun 2018 were reviewed retrospectively for primary failure, which needed laparoscopic revision. We studied the causes of malfunction, laparoscopic surgical techniques and its outcome. Results: 149 TC were inserted. The total incidence of primary failure of TC was 25 (16.7%). The causes of TC malfunction were blocked catheter in 21 patients (84%) and migrated catheter in four patients (16%). The mean age of patients who underwent revision surgery was 40.9 (SD: 15.01) years old and the mean BMI was 23.7 (SD: 3.63). The mean primary latency was 6.9 (SD: 9.03) months. There were three reported secondary failures where the patients converted to hemodialysis post operatively; one was due adhesion and another two were due to peritonitis. At median follow up duration of 10 months, 23 (88%) TC maintains patency while 3 (22%) secondary failure was reported in two patients due to peritonitis and severe intraperitoneal adhesions respectively. Survival of TC after laparoscopic revision was analysed using Kaplan Meier curve indicates that 88% of TCs were able to maintain patency at 12 and 24 months. Conclusion: Laparoscopic TC salvage is a worthwhile endeavor to prolong patency for CAPD.

Turkish journal of urology, Apr 7, 2022

Objective: Degloving perineal injury is defined as avulsion of the perineal skin and subcutaneous... more Objective: Degloving perineal injury is defined as avulsion of the perineal skin and subcutaneous tissue from its surrounding fascia, bone, and organs. This injury is most commonly caused by road vehicle accidents or alleged falls from heights. This devastating injury is associated with high morbidity and mortality if mismanaged. We retrospectively evaluated our management protocol for degloving perineal injury and the clinical outcomes of our case series. Material and Methods: Six cases of open perineal degloving injuries were managed and retrospectively reviewed at our center from 2018 to 2020, comprising 2 cases of isolated degloving wounds of the scrotum and 4 cases of complex perineal injuries associated with pelvic fracture, anorectal injuries, or complete transacted urethral injuries. Two of the 6 patients had open-book pelvic fractures that required pelvic stabilization. Results: Complex degloving perineal injuries can be managed through (1) resuscitation and pelvic packing; (2) urgent life-threatening treatments; (3) pelvic exploration with debridement; and (4) primary repair of anorectal or transacted urethral injuries with external pelvic fixation. All patients promptly underwent surgical repair after immediate diagnosis and resuscitation. Additionally, patients were operated by specialized teams according to the proposed management approach as shown in Figure 1. All patients recovered well and had good functional outcomes. Conclusion: A multidisciplinary team comprising general surgeons, urologists, orthopedic surgeons, and plastic surgeons was involved in this review. Prompt diagnosis and immediate surgical intervention remain the standard requirements for complex degloving perineal injuries. We proposed a management protocol that is safe for managing complex perineal injuries.

Introduction: Changes in voiding positionmay have signi ficant impact on micturitiondue to factors... more Introduction: Changes in voiding positionmay have signi ficant impact on micturitiondue to factors such as changes in pressureof abdominal muscles and viscera, andrelaxation of pelvic floor muscles in differ-ent voiding positions. Few studies in the lit-erature have addressed the impact ofvoiding position on uroflowmetric results,however, the results were inconclusive.Objectives: To investigate the uroflowme-try findings of three different voiding posi-tions in BPO patients attending theUrology Clinic, HTAA.Materials and Methods: Cross-sectionalobservational study of BPO patientsattending the Urology Clinic HTAA fromMarch 2015 to December 2015.Uroflowmetry in standing, sitting andsquatting positions were done in those ful-filling the study criteria. The maximumflow rate, average flow rate, voiding vol-ume, total voiding time and post-voidingresidual volume were measured andrecorded. The results were then comparedand analysed. Other factors such as nor-mal voiding habit, number of medication,...

Introduction Glans penis gangrene is a rare condition that carries special challenges in managing... more Introduction Glans penis gangrene is a rare condition that carries special challenges in managing the problem. It is usually associated with vascular insufficiency and amputation is required to prevent spread of infection from the necrotic tissue. While most penile gangrene presented on top of Fournier's gangrene, this particular case presented with isolated glans penis gangrene. Case Report A 60 year-old man, known case of diabetes mellitus, presented with lethargy and poor oral intake for past 1 month. He denied having any prior urinary symptoms, external device applications or trauma. He was treated as having hyperosmolar hyperglycemic state. At catheterization there was blackish discoloration over the glans penis with erythema of surrounding penile shaft. Foley catheter was successfully inserted. His blood investigations were suggestive of infection and acute renal injury secondary to dehydration. Urine analysis was clear of infection. Parenteral Ampicillin and Metronidazole...

Institut Terjemahan & Buku Malaysia & Universiti Islam Antarabangsa Malaysia, 2018

Inverted papilloma of the urinary bladder is rare. In the paediatric group, this condition is eve... more Inverted papilloma of the urinary bladder is rare. In the paediatric group, this condition is even more rare. To date only five cases have been reported in the English literature. Due to its rarity, the morphology and biological behaviour are still uncertain. We report a case of inverted papilloma of the urinary bladder in a 12-year-old girl who presented with recurrent haematuria. The patient’s symptoms resolved after endoscopic resection with no recurrence on cystoscopy surveillance for last two years. The magnetic resonance imaging features of this lesion are described.

Introduction & Objective: Incidence of urolithiasis is high in our country. Treatment modalities ... more Introduction & Objective: Incidence of urolithiasis is high in our country. Treatment modalities vary depending to the size and location of stone and patient's fitness for invasive treatment. Identifying the most suitable treatment modalities according to patient's clinical characteristic is important to get optimum stone clearance with least complication and better cost-benefit. General Objectives 1. To prove that primary RIRS is more effective than ESWL in treatment of renal stone with suspected failure of ESWL Specific objectives 1. To show that RIRS has better stone clearance in treatment of renal stone with suspected failure of ESWL 2. To show that RIRS is more cost effective in treatment of renal stone with suspected failure of ESWL 3. To identify factors that favors RIRS than ESWL in treatment of renal stone with suspected failure of ESWL Materials and Methods: This is a randomized controlled trial done for a period of two years from from August 2014 to July 2016 in H...

Urinary bladder stone affected humankind since antiquity. It disease was noted in Egyptian manusc... more Urinary bladder stone affected humankind since antiquity. It disease was noted in Egyptian manuscript more than 3500 BC. Along the history it management also evolve from perineum extraction to endoscopic management. Recent review article on urinary bladder stone management suggested percutaneous stone management for stone between 2-4cm sizes.

Journal of Men's Health, 2011

Urinary bladder diverticulum tumour is rare. It has been estimated that only 2.6% of all bladder ... more Urinary bladder diverticulum tumour is rare. It has been estimated that only 2.6% of all bladder diverticulum develop malignancy and most were diagnosed late. Delay in diagnosis can be due to presence of intra-diverticular stone which can compress and hide any evidence of mucosal changes. We report the case of a 53-year-old man who presented with multiple lower urinary tract stone including in the urethra, bladder and bladder diverticulum. Serial investigations before a diagnosis of a bladder diverticulum adenocarcinoma were made. The tumour was hidden behind a stone.

Malaysian Journal of Medical Sciences

Background: Penile augmentation using injection of a foreign body into penile skin was mainly per... more Background: Penile augmentation using injection of a foreign body into penile skin was mainly performed by non-medical personnel. Majority of these patients end up with complication of an abnormal mass formation known as penile paraffinoma. Methods: We described three different surgical techniques for correction of penile paraffinoma based on our single-centre experience. Informed consents were obtained from patients whose photographs were taken during the operation step. Results: In general, three patients had simple excision biopsy with primary suturing, four patients underwent single stage excision of circumferential granuloma with bilateral scrotal skin flap reconstruction and one patient experienced dual stage procedure. Three of them were injected with paraffin, one with silicone and the remaining four were unable to identify the substance used. All patients successfully underwent the surgical procedure and four of them had minor postoperative surgical site infection and wound gapping. Conclusion: All patients recovered well and the mean International Index of Erectile Function (IIEF-5) score obtained was 24.25. In our experience, excision biopsy was adequate for focal mass and reconstructive surgery using bilateral scrotal flap was suitable for circumferential mass.

African Journal of Urology, 2021

Background To describe our scrotal bridge flap technique in reconstructive surgery for extensive ... more Background To describe our scrotal bridge flap technique in reconstructive surgery for extensive penile paraffinoma, a debilitating late complication of penile subcutaneous foreign material injection intended to achieve penile augmentation. Case presentation We reviewed the medical records of 10 patients who underwent reconstructive surgery with the scrotal bridge flap technique for penile paraffinoma at our center between 2016 and 2019. Complete excision of fibrotic tissue and the overlying skin was performed, and penile resurfacing was achieved by mobilizing the scrotal skin superiorly to wrap around the penile shaft, leaving a skin bridge at the median raphe. All 10 patients successfully underwent scrotal bridge flap penile reconstruction with satisfying results. The mean operation duration was 286.1 min (range 213–363 min). No immediate major complications were observed in any of the patients, and no patients required revision surgery. Conclusion The scrotal bridge flap techniqu...

Malaysian Family Physician

Background: A penile median raphe cyst is an uncommon congenital lesion that is formed due to fai... more Background: A penile median raphe cyst is an uncommon congenital lesion that is formed due to failure of the median raphe to close completely during embryo development. The majority of the cysts are asymptomatic and often go unnoticed. Here, we report acute urinary retention as a very rare complication of a penile median raphe cyst. Case presentation: A 21-year-old single man presented with a sudden onset of acute urinary retention of one days’ duration. Urethral catheterization was done at the Emergency Department and this drained 800 ml of urine. On further questioning, he claimed that he had had a painless nodule at the glans penis since childhood. The swelling increased in size in the past week causing discomfort. He denied any history of genitalia trauma or recent sexual intercourse. On examination, there was a bluish lesion over the ventral aspect of the glans penis measuring about 3 x 2 cm. The lesion was later excised and histopathology revealed a median raphe cyst of the pe...