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author:("alwall, amrad")
1.  Lupus cystitis presenting with urinary symptoms 
Urology Annals  2015;7(3):414-415.
We present a case of a young woman presenting with irritative lower urinary tract symptoms and microscopic hematuria who was diagnosed with systemic lupus erythematosus (SLE). Abdominal ultrasound revealed bilateral hydronephrosis and a thickened bladder wall. Cystoscopic evaluation revealed severe diffuse inflammation, erythema and hemorrhage at the trigone with punctate extensions to the bladder base. She was treated with prednisone and mycophenolate mofetil with improvements in her symptoms and ultrasound findings. Lupus cystitis is a rare manifestation of SLE.
PMCID: PMC4518391  PMID: 26229342
Cystitis; lower urinary tract symptoms; systemic lupus erythematosus
2.  Transfer of skills on LapSim virtual reality laparoscopic simulator into the operating room in urology 
Urology Annals  2015;7(2):172-176.
Assessing the predictive validity of the LapSim simulator within a urology residency program.
Materials and Methods:
Twelve urology residents at McGill University were enrolled in the study between June 2008 and December 2011. The residents had weekly training on the LapSim that consisted of 3 tasks (cutting, clip-applying, and lifting and grasping). They underwent monthly assessment of their LapSim performance using total time, tissue damage and path length among other parameters as surrogates for their economy of movement and respect for tissue. The last residents’ LapSim performance was compared with their first performance of radical nephrectomy on anesthetized porcine models in their 4th year of training. Two independent urologic surgeons rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Nonparametric spearman correlation test was used to compare each rater's cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the LapSim simulator.
The kappa results demonstrated acceptable agreement between the two observers among all domains of the rating scale of performance except for confidence of movement and efficiency. In addition, poor predictive validity of the LapSim simulator was demonstrated.
Predictive validity was not demonstrated for the LapSim simulator in the context of a urology residency training program.
PMCID: PMC4374254  PMID: 25838162
Laparoscopic simulator; LapSim; minimally invasive surgery training
3.  Prospects of stem cell treatment in benign urological diseases 
Korean Journal of Urology  2015;56(4):257-265.
Stem cells (SCs) are undifferentiated cells that are capable of self-renewal and differentiation and that therefore contribute to the renewal and repair of tissues. Their capacity for division, differentiation, and tissue regeneration is highly dependent on the surrounding environment. Several preclinical and clinical studies have utilized SCs in urological disorders. In this article, we review the current status of SC use in benign urological diseases (erectile dysfunction, Peyronie disease, infertility, and urinary incontinence), and we summarize the results of the preclinical and clinical trials that have been conducted.
PMCID: PMC4392024  PMID: 25874038
Erectile dysfunction; Infertility; Stem cells; Urinary incontinence
4.  The incidence of erectile dysfunction after pelvic fracture urethral injury: A systematic review and meta-analysis 
Arab Journal of Urology  2014;13(1):68-74.
Pelvic fracture urethral injury (PFUI) is associated with a high risk of erectile dysfunction (ED). The effect of the type of posterior urethral disruption repair on erectile function has not been clearly established. We systematically reviewed and conducted a meta-analysis of the proportion of patients with ED at (i) baseline after pelvic fracture with PFUI, (ii) after immediate primary realignment, and (iii) after delayed urethroplasty.
Using search terms for primary realignment or urethroplasty and urethral disruption, we systematically reviewed PubMed and EMBASE. A meta-analysis of the proportion of patients with ED was conducted assuming a random-effects model.
Of 734 articles found, 24 met the inclusion criteria. The estimate of the proportion (95% confidence interval) of patients with ED after (i) PFUI was 34 (25–45)%, after (ii) immediate primary realignment was 16 (8–26)%, and after (iii) delayed urethroplasty was an additional 3 (2–5)% more than the 34% after pelvic fracture in this cohort.
After pelvic fracture, 34% of patients had ED. After primary endoscopic alignment, patients had a lower reported rate of ED (16%). Delayed urethroplasty conferred an additional 3% risk above the 34% associated with PFUI alone, with 37% of patients having de novo ED. The difference in de novo ED after primary endoscopic alignment vs. delayed urethroplasty is probably due to reporting differences in ED and/or patients with less severe injury undergoing primary realignment.
PMCID: PMC4435659  PMID: 26019983
PFUI, pelvic fracture urethral injury; ED, erectile dysfunction; IIEF, International Index of Erectile Function; Erectile dysfunction; Meta-analysis; Systematic review; Urethral disruption; Pelvic fracture
5.  The incidence, causes, mechanism, risk factors, classification, and diagnosis of pelvic fracture urethral injury 
Arab Journal of Urology  2014;13(1):2-6.
Pelvic fracture urethral injury (PFUI) is an uncommon but potentially devastating result of pelvic fracture. It ranges in severity based on the cause and the mechanism of injury.
We reviewed previous reports to identify the incidence, causes, mechanisms of injury and risk factors of PFUI. In addition, we reviewed the current classification systems and diagnostic methods that have been described to assess the severity of PFUI, to identify optimal management strategies and evaluate outcomes.
PFUI occurs more commonly in men, but is more likely to be severe in children. The most common cause is motor vehicle collisions, and the mechanism is typically a ligament rupture at the attachment to the urethra. There is no reliable classification system to differentiate partial and complete PFUI. Retrograde urethrography is the standard imaging method but it has its limitations.
Despite many reports describing this injury, there is still a need to further clarify the incidence, aetiology and mechanism of injury to better determine optimal management strategies and evaluate outcomes. Consensus in the diagnosis of PFUI is lacking, and outcomes of primary realignment and the role of flexible cystoscopy as a diagnostic method are still to be determined.
PMCID: PMC4435767  PMID: 26019970
PFUI, pelvic fracture urethral injury; PFUDD, pelvic fracture urethral distraction defect; MVC, motor vehicle collision; BN, bladder neck; RUG, retrograde urethrography; Pelvic fracture; Urethral injury; Classification; Diagnosis
6.  Percutaneous Holmium Laser Fulguration of Calyceal Diverticula 
Case Reports in Urology  2012;2012:716786.
Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously.
PMCID: PMC3352233  PMID: 22606636
7.  Future prospects in the treatment of erectile dysfunction: focus on avanafil 
The treatment of erectile dysfunction (ED) has been revolutionized in the last 15 years with the introduction of type 5 phosphodiesterase (PDE5) inhibitors. Their efficacy, safety, and ease of administration have made them first-line treatment for ED. This article reviews the current therapies available for ED, and the new PDE5 inhibitors that are being investigated. Furthermore, it examines all the current ED treatment options that are in different phases of development (including oral and topical pharmacotherapy, gene therapy, and tissue engineering). A special emphasis is on avanafil, a new PDE5 inhibitor that has been studied extensively in Phase I and II clinical trials and has undergone several Phase III trials. Avanafil is a promising medication for ED due to its favorable pharmacokinetics, safety, and efficacy.
PMCID: PMC3210072  PMID: 22087063
PDE5; sexual performance; pharmacokinetics

Results 1-7 (7)