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Papers by Mohamed Elkoushy
World Journal of Urology, 2015
The aim of the present study was to compare the accuracy of the Guy's and... more The aim of the present study was to compare the accuracy of the Guy's and S.T.O.N.E. scoring systems in predicting percutaneous nephrolithotomy (PCNL) outcomes. After obtaining ethics approval, medical records of patients undergoing PCNL between 2009 and 2013 at a tertiary stone center were retrospectively reviewed. Guy's and S.T.O.N.E. scoring systems were calculated. Regression analysis and ROC curves were performed. A total of 185 PCNLs were reviewed. The overall stone-free rate was 71.9 % with a complication rate of 16.2 %. When compared to patients with residual fragments, stone-free patients had significantly lower Guy's grade (2.7 vs. 2; p < 0.001) and S.T.O.N.E. score (8.3 vs. 7.4; p = 0.004). Logistic regression analysis showed that both Guy's and S.T.O.N.E. systems were significantly associated with stone-free status, OR 0.4 (p < 0.001), and OR 0.7 (p = 0.001), respectively. Furthermore, both scoring systems were significantly associated with the estimated blood loss (p = 0.01 and p = 0.005). There was good correlation between both scoring systems and operative time (r = 0.3, p < 0.001 and r = 0.4, p < 0.001) and length of hospital stay (r = 0.2, p = 0.001 and r = 0.3, p < 0.001). However, there were no significant associations between both scoring systems and complications (p = 0.7 and p = 0.6). There was no significant difference in the areas under the curves for the Guy's and S.T.O.N.E. scoring systems (0.74 [95 % CI 0.66-0.82] vs. 0.63 [95 % CI 0.54-0.72]; p = 0.06). Both Guy's and S.T.O.N.E scoring systems have comparable accuracies in predicting post-PCNL stone-free status. Other factors not included in either scoring system may need to be incorporated in the future to increase their accuracy.
Smith/Smith's Textbook of Endourology, 2012
European Urology Supplements, 2015
The aim of the present study was to compare the accuracy of the Guy's and... more The aim of the present study was to compare the accuracy of the Guy's and S.T.O.N.E. scoring systems in predicting percutaneous nephrolithotomy (PCNL) outcomes. After obtaining ethics approval, medical records of patients undergoing PCNL between 2009 and 2013 at a tertiary stone center were retrospectively reviewed. Guy's and S.T.O.N.E. scoring systems were calculated. Regression analysis and ROC curves were performed. A total of 185 PCNLs were reviewed. The overall stone-free rate was 71.9 % with a complication rate of 16.2 %. When compared to patients with residual fragments, stone-free patients had significantly lower Guy's grade (2.7 vs. 2; p < 0.001) and S.T.O.N.E. score (8.3 vs. 7.4; p = 0.004). Logistic regression analysis showed that both Guy's and S.T.O.N.E. systems were significantly associated with stone-free status, OR 0.4 (p < 0.001), and OR 0.7 (p = 0.001), respectively. Furthermore, both scoring systems were significantly associated with the estimated blood loss (p = 0.01 and p = 0.005). There was good correlation between both scoring systems and operative time (r = 0.3, p < 0.001 and r = 0.4, p < 0.001) and length of hospital stay (r = 0.2, p = 0.001 and r = 0.3, p < 0.001). However, there were no significant associations between both scoring systems and complications (p = 0.7 and p = 0.6). There was no significant difference in the areas under the curves for the Guy's and S.T.O.N.E. scoring systems (0.74 [95 % CI 0.66-0.82] vs. 0.63 [95 % CI 0.54-0.72]; p = 0.06). Both Guy's and S.T.O.N.E scoring systems have comparable accuracies in predicting post-PCNL stone-free status. Other factors not included in either scoring system may need to be incorporated in the future to increase their accuracy.
The Journal of Urology, 2015
The Journal of Urology, 2013
The Journal of Urology, 2014
The Journal of Urology, 2012
The Journal of Urology, 2012
LG-380 is a relatively new electrohydraulic lithotripter that produces a low peak positive pressu... more LG-380 is a relatively new electrohydraulic lithotripter that produces a low peak positive pressure and has the widest focal zone (ϳ20 mm dia.) of any clinical lithotripter. Previous laboratory studies with this machine, using a multi-step power ramping protocol (PL-1 to 8 at 50 SWs each step, PL-9 for 2,600 SWs) at slow SW-rate (60 SWs/min), produced a small kidney lesion measuring only 0.05Ϯ0.03% of the functional renal volume (FRV) in our pig model (J Urol 181(4S):665, 2009). Since treatment philosophy can vary and not all clinical lithotripsy centers may use treatment protocols that incorporate slow SW-rate or gradual power ramping, we assessed the potential for injury at high-end settings with this lithotripter.
Journal of Endourology Part B, Videourology, 2014
Background and Objectives: Radiation is one of the occupational hazards urologists are exposed to... more Background and Objectives: Radiation is one of the occupational hazards urologists are exposed to during their day-to-day practice. Excessive radiation exposure is associated with multiple short-and longterm consequences. This educational video demonstrates the important measures urologists could undertake to protect patients, themselves, and other healthcare professionals from excessive radiation exposure without compromising outcomes. Methods: As Low As Reasonably Achievable principles, including minimizing time, maximizing distance, and always using shields, are demonstrated. Intraoperative tricks to minimize radiation exposure are recommended, including using the foot pedal to activate fluoroscopy by the surgeon himself/herself, using pulsed fluoroscopy, and documenting fluoroscopy time. In addition, the American Urological Association (AUA) guidelines regarding imaging modalities used for follow-up of urolithiasis are reviewed. Results: Surgeon behavior is one of the important modifiable predictors of fluoroscopy time during endourological procedures. In one study, fluoroscopy time during ureteroscopy was reduced by 24% by simply providing periodic feedback consisting of each urologist's mean fluoroscopy time compared with his peers. 1 In a survey of endourologists, there was good compliance (97%) with chest and pelvic shields. However, their compliance with other radiation safety measures needed to be improved. 2 Similar to surgeon behavior, there were significant differences among postgraduate trainees 3 and radiological technologists 4 in their use of fluoroscopy during ureteroscopy and shockwave lithotripsy, respectively. When compared with standard fluoroscopy at 30 frames per second, pulsed fluoroscopy at 4 frames per second significantly decreased fluoroscopy times by more than 60% during ureteroscopy and percutaneous nephrolithotomy. 5 Finally, the 2012 AUA guidelines recommended low-dose CT scan protocols instead of standard CT scans in thin patients with body mass index < 30 kg/m 2 . 6 Furthermore, patients with radio-opaque stones should be followed with plain radiographs with ultrasonography rather than CT scans to minimize radiation exposure. 6
Journal of Endourology, 2014
Abstract Background and Purpose: Tubeless percutaneous nephrolithotomy (PCNL) has gained populari... more Abstract Background and Purpose: Tubeless percutaneous nephrolithotomy (PCNL) has gained popularity in an attempt to decrease morbidity and accelerate discharge. Recently, ambulatory tubeless PCNL has been reported. There are no data, however, regarding readmission rates of patients who had ambulatory PCNL. Therefore, the aim of this study was to assess rates of emergency department (ED) visits and readmissions postambulatory PCNL. Patients and Methods: A retrospective chart review of all ambulatory PCNL cases at two institutions between March 2007 and December 2013 was performed. Preoperative, intraoperative, and postoperative data were collected including the amount of narcotics used, length of hospital stay, postoperative complications, returns to the ED, and readmissions. Results: Fifty patients underwent ambulatory PCNL, including two bilateral cases, making up a total of 52 renal units. All patients were discharged home on the same day with a mean hospital stay of 208.32±73.43 minutes. The mean narcotic requirement was 41.13±46.76 mg of oral morphine equivalents. Six patients (12%) returned to the ED, all within 7 days. Four of these 6 patients were discharged; three with stent colic and one with wound cellulitis. Only two (4%) patients were readmitted-one with multiresistant Escherichia coli and one with uncomplicated stent colic. Overall stone-free rate was 90.4%. There were no major complications, while low grade (I-II) Clavien complications developed in 9 (18%) patients. Conclusion: Ambulatory PCNL is safe in highly selected patients with a stone-free rate of 90% and readmission rate of 4%. Prospective studies comparing standard PCNL with ambulatory PCNL are warranted.
African Journal of Urology, 2010
Objectives: Intravesical Bacillus Calmette-Guérin (BCG) vaccine is the mainstay of treatment and ... more Objectives: Intravesical Bacillus Calmette-Guérin (BCG) vaccine is the mainstay of treatment and prophylaxis in superficial bladder cancer (SBC) as it reduces tumor recurrence and disease progression. About one-third of patients do not respond to BCG. The aim of this study was to determine the efficacy of intravesical gemcitabine in patients with BCG-refractory SBC. Methods: Twenty three patients with SBC; TaG3, T1G2-G3 or carcinoma in situ (CIS), refractory (after at least 2 courses of intravesical BCG) or intolerant to intravesical BCG therapy were included. Two weeks after complete tumor resection, patients received intravesical gemcitabine twice weekly at a dose of 2.000 mg/100 ml normal saline for 6 consecutive weeks. Two months after the last dose, recurrence-free patients underwent cystoscopy, urinary cytology and 6 random bladder biopsies. Thereafter, patients were evaluated by the same measures every 3 months, as long as there was no recurrence. Patients with complete response (negative cytology and random biopsies) at the first follow-up cystoscopy received a similar maintenance dose once weekly for another 6 weeks. Results: Twenty one patients completed the study: 15 males and 6 females with a mean age of 48.1 (38-72) years. The follow-up was 15 months (range 2-19 months). Thirteen (61.9%) patients were recurrence-free after a mean of 17 months. Superficial recurrences were detected in 6 (28.6%) patients and progression by stage in 2 patients (9.5%). During follow-up, 8 patients had tumor recurrences and 2 had progression to a higher stage. The median recurrence-free time was 14.7 months (5-19 months). The drug was well tolerated and side-effects were mild in all patients, except two: one had easily controlled hematuria and the other had leucopenia. Conclusion: In properly selected patients, gemcitabine seems to be a promising option in the management of high-risk BCG-refractory SBC, especially in those who refuse or are unfit for cystectomy. Long-term efficacy and the role of maintenance therapy have to be properly studied.
The Journal of Urology, 2012
The Journal of Urology, 2012
The Journal of Urology, 2015
The Journal of Urology, 2014
World Journal of Urology, 2015
The aim of the present study was to compare the accuracy of the Guy&amp;amp;amp;#39;s and... more The aim of the present study was to compare the accuracy of the Guy&amp;amp;amp;#39;s and S.T.O.N.E. scoring systems in predicting percutaneous nephrolithotomy (PCNL) outcomes. After obtaining ethics approval, medical records of patients undergoing PCNL between 2009 and 2013 at a tertiary stone center were retrospectively reviewed. Guy&amp;amp;amp;#39;s and S.T.O.N.E. scoring systems were calculated. Regression analysis and ROC curves were performed. A total of 185 PCNLs were reviewed. The overall stone-free rate was 71.9 % with a complication rate of 16.2 %. When compared to patients with residual fragments, stone-free patients had significantly lower Guy&amp;amp;amp;#39;s grade (2.7 vs. 2; p &amp;amp;amp;lt; 0.001) and S.T.O.N.E. score (8.3 vs. 7.4; p = 0.004). Logistic regression analysis showed that both Guy&amp;amp;amp;#39;s and S.T.O.N.E. systems were significantly associated with stone-free status, OR 0.4 (p &amp;amp;amp;lt; 0.001), and OR 0.7 (p = 0.001), respectively. Furthermore, both scoring systems were significantly associated with the estimated blood loss (p = 0.01 and p = 0.005). There was good correlation between both scoring systems and operative time (r = 0.3, p &amp;amp;amp;lt; 0.001 and r = 0.4, p &amp;amp;amp;lt; 0.001) and length of hospital stay (r = 0.2, p = 0.001 and r = 0.3, p &amp;amp;amp;lt; 0.001). However, there were no significant associations between both scoring systems and complications (p = 0.7 and p = 0.6). There was no significant difference in the areas under the curves for the Guy&amp;amp;amp;#39;s and S.T.O.N.E. scoring systems (0.74 [95 % CI 0.66-0.82] vs. 0.63 [95 % CI 0.54-0.72]; p = 0.06). Both Guy&amp;amp;amp;#39;s and S.T.O.N.E scoring systems have comparable accuracies in predicting post-PCNL stone-free status. Other factors not included in either scoring system may need to be incorporated in the future to increase their accuracy.
Smith/Smith's Textbook of Endourology, 2012
European Urology Supplements, 2015
The aim of the present study was to compare the accuracy of the Guy&amp;amp;amp;#39;s and... more The aim of the present study was to compare the accuracy of the Guy&amp;amp;amp;#39;s and S.T.O.N.E. scoring systems in predicting percutaneous nephrolithotomy (PCNL) outcomes. After obtaining ethics approval, medical records of patients undergoing PCNL between 2009 and 2013 at a tertiary stone center were retrospectively reviewed. Guy&amp;amp;amp;#39;s and S.T.O.N.E. scoring systems were calculated. Regression analysis and ROC curves were performed. A total of 185 PCNLs were reviewed. The overall stone-free rate was 71.9 % with a complication rate of 16.2 %. When compared to patients with residual fragments, stone-free patients had significantly lower Guy&amp;amp;amp;#39;s grade (2.7 vs. 2; p &amp;amp;amp;lt; 0.001) and S.T.O.N.E. score (8.3 vs. 7.4; p = 0.004). Logistic regression analysis showed that both Guy&amp;amp;amp;#39;s and S.T.O.N.E. systems were significantly associated with stone-free status, OR 0.4 (p &amp;amp;amp;lt; 0.001), and OR 0.7 (p = 0.001), respectively. Furthermore, both scoring systems were significantly associated with the estimated blood loss (p = 0.01 and p = 0.005). There was good correlation between both scoring systems and operative time (r = 0.3, p &amp;amp;amp;lt; 0.001 and r = 0.4, p &amp;amp;amp;lt; 0.001) and length of hospital stay (r = 0.2, p = 0.001 and r = 0.3, p &amp;amp;amp;lt; 0.001). However, there were no significant associations between both scoring systems and complications (p = 0.7 and p = 0.6). There was no significant difference in the areas under the curves for the Guy&amp;amp;amp;#39;s and S.T.O.N.E. scoring systems (0.74 [95 % CI 0.66-0.82] vs. 0.63 [95 % CI 0.54-0.72]; p = 0.06). Both Guy&amp;amp;amp;#39;s and S.T.O.N.E scoring systems have comparable accuracies in predicting post-PCNL stone-free status. Other factors not included in either scoring system may need to be incorporated in the future to increase their accuracy.
The Journal of Urology, 2015
The Journal of Urology, 2013
The Journal of Urology, 2014
The Journal of Urology, 2012
The Journal of Urology, 2012
LG-380 is a relatively new electrohydraulic lithotripter that produces a low peak positive pressu... more LG-380 is a relatively new electrohydraulic lithotripter that produces a low peak positive pressure and has the widest focal zone (ϳ20 mm dia.) of any clinical lithotripter. Previous laboratory studies with this machine, using a multi-step power ramping protocol (PL-1 to 8 at 50 SWs each step, PL-9 for 2,600 SWs) at slow SW-rate (60 SWs/min), produced a small kidney lesion measuring only 0.05Ϯ0.03% of the functional renal volume (FRV) in our pig model (J Urol 181(4S):665, 2009). Since treatment philosophy can vary and not all clinical lithotripsy centers may use treatment protocols that incorporate slow SW-rate or gradual power ramping, we assessed the potential for injury at high-end settings with this lithotripter.
Journal of Endourology Part B, Videourology, 2014
Background and Objectives: Radiation is one of the occupational hazards urologists are exposed to... more Background and Objectives: Radiation is one of the occupational hazards urologists are exposed to during their day-to-day practice. Excessive radiation exposure is associated with multiple short-and longterm consequences. This educational video demonstrates the important measures urologists could undertake to protect patients, themselves, and other healthcare professionals from excessive radiation exposure without compromising outcomes. Methods: As Low As Reasonably Achievable principles, including minimizing time, maximizing distance, and always using shields, are demonstrated. Intraoperative tricks to minimize radiation exposure are recommended, including using the foot pedal to activate fluoroscopy by the surgeon himself/herself, using pulsed fluoroscopy, and documenting fluoroscopy time. In addition, the American Urological Association (AUA) guidelines regarding imaging modalities used for follow-up of urolithiasis are reviewed. Results: Surgeon behavior is one of the important modifiable predictors of fluoroscopy time during endourological procedures. In one study, fluoroscopy time during ureteroscopy was reduced by 24% by simply providing periodic feedback consisting of each urologist's mean fluoroscopy time compared with his peers. 1 In a survey of endourologists, there was good compliance (97%) with chest and pelvic shields. However, their compliance with other radiation safety measures needed to be improved. 2 Similar to surgeon behavior, there were significant differences among postgraduate trainees 3 and radiological technologists 4 in their use of fluoroscopy during ureteroscopy and shockwave lithotripsy, respectively. When compared with standard fluoroscopy at 30 frames per second, pulsed fluoroscopy at 4 frames per second significantly decreased fluoroscopy times by more than 60% during ureteroscopy and percutaneous nephrolithotomy. 5 Finally, the 2012 AUA guidelines recommended low-dose CT scan protocols instead of standard CT scans in thin patients with body mass index < 30 kg/m 2 . 6 Furthermore, patients with radio-opaque stones should be followed with plain radiographs with ultrasonography rather than CT scans to minimize radiation exposure. 6
Journal of Endourology, 2014
Abstract Background and Purpose: Tubeless percutaneous nephrolithotomy (PCNL) has gained populari... more Abstract Background and Purpose: Tubeless percutaneous nephrolithotomy (PCNL) has gained popularity in an attempt to decrease morbidity and accelerate discharge. Recently, ambulatory tubeless PCNL has been reported. There are no data, however, regarding readmission rates of patients who had ambulatory PCNL. Therefore, the aim of this study was to assess rates of emergency department (ED) visits and readmissions postambulatory PCNL. Patients and Methods: A retrospective chart review of all ambulatory PCNL cases at two institutions between March 2007 and December 2013 was performed. Preoperative, intraoperative, and postoperative data were collected including the amount of narcotics used, length of hospital stay, postoperative complications, returns to the ED, and readmissions. Results: Fifty patients underwent ambulatory PCNL, including two bilateral cases, making up a total of 52 renal units. All patients were discharged home on the same day with a mean hospital stay of 208.32±73.43 minutes. The mean narcotic requirement was 41.13±46.76 mg of oral morphine equivalents. Six patients (12%) returned to the ED, all within 7 days. Four of these 6 patients were discharged; three with stent colic and one with wound cellulitis. Only two (4%) patients were readmitted-one with multiresistant Escherichia coli and one with uncomplicated stent colic. Overall stone-free rate was 90.4%. There were no major complications, while low grade (I-II) Clavien complications developed in 9 (18%) patients. Conclusion: Ambulatory PCNL is safe in highly selected patients with a stone-free rate of 90% and readmission rate of 4%. Prospective studies comparing standard PCNL with ambulatory PCNL are warranted.
African Journal of Urology, 2010
Objectives: Intravesical Bacillus Calmette-Guérin (BCG) vaccine is the mainstay of treatment and ... more Objectives: Intravesical Bacillus Calmette-Guérin (BCG) vaccine is the mainstay of treatment and prophylaxis in superficial bladder cancer (SBC) as it reduces tumor recurrence and disease progression. About one-third of patients do not respond to BCG. The aim of this study was to determine the efficacy of intravesical gemcitabine in patients with BCG-refractory SBC. Methods: Twenty three patients with SBC; TaG3, T1G2-G3 or carcinoma in situ (CIS), refractory (after at least 2 courses of intravesical BCG) or intolerant to intravesical BCG therapy were included. Two weeks after complete tumor resection, patients received intravesical gemcitabine twice weekly at a dose of 2.000 mg/100 ml normal saline for 6 consecutive weeks. Two months after the last dose, recurrence-free patients underwent cystoscopy, urinary cytology and 6 random bladder biopsies. Thereafter, patients were evaluated by the same measures every 3 months, as long as there was no recurrence. Patients with complete response (negative cytology and random biopsies) at the first follow-up cystoscopy received a similar maintenance dose once weekly for another 6 weeks. Results: Twenty one patients completed the study: 15 males and 6 females with a mean age of 48.1 (38-72) years. The follow-up was 15 months (range 2-19 months). Thirteen (61.9%) patients were recurrence-free after a mean of 17 months. Superficial recurrences were detected in 6 (28.6%) patients and progression by stage in 2 patients (9.5%). During follow-up, 8 patients had tumor recurrences and 2 had progression to a higher stage. The median recurrence-free time was 14.7 months (5-19 months). The drug was well tolerated and side-effects were mild in all patients, except two: one had easily controlled hematuria and the other had leucopenia. Conclusion: In properly selected patients, gemcitabine seems to be a promising option in the management of high-risk BCG-refractory SBC, especially in those who refuse or are unfit for cystectomy. Long-term efficacy and the role of maintenance therapy have to be properly studied.
The Journal of Urology, 2012
The Journal of Urology, 2012
The Journal of Urology, 2015
The Journal of Urology, 2014