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  1. Article: Practice patterns in ordering a voiding cystourethrogram for pediatric patients among different specialties in a Middle Eastern tertiary care center.

    Hout, Mohammad / Aoun, Bilal / Atweh, Lamya Ann / Merhe, Ali / El-Hout, Yaser

    Urology annals

    2019  Volume 11, Issue 2, Page(s) 168–170

    Abstract: Introduction: Voiding cystourethrogram (VCUG) is a very popular test performed to evaluate genitourinary tract anomalies. Nevertheless, this test can be overused and can lead to unnecessary patient discomfort, radiation exposure, and cost. We sought to ... ...

    Abstract Introduction: Voiding cystourethrogram (VCUG) is a very popular test performed to evaluate genitourinary tract anomalies. Nevertheless, this test can be overused and can lead to unnecessary patient discomfort, radiation exposure, and cost. We sought to study the practice patterns in ordering a VCUG in a Middle Eastern tertiary care center.
    Methods: Over a period of 3 years, a retrospective analysis of all VCUG images done for pediatric patients in a single center was made. Further clinical details were extracted from the electronic health records. The specialty of an ordering physician and the reported indication for the procedure were noted. Indications for VCUG were recorded based on the AAP 2011 guidelines, NICE guidelines 2007, and ACR 2011 guidelines. Based on these criteria, patients were analyzed.
    Results: A total of 92 VCUGs were evaluated. Of all VCUGs done, pediatricians ordered the most VCUGs (50/92), followed by pediatric infectious disease (16/92), pediatric nephrology (9/92), pediatric urology (7/92), adult urology (5/92), pediatric surgery (3/92), obstetrician-gynecologist (1/92), and emergency medicine (1/92). Properly indicated VCUGs were 50% by general pediatrics, 55% by pediatric infectious disease, 45% by pediatric nephrology, 40% by adult urology, 33% by pediatric surgery, and 100% by pediatric urology.
    Conclusion: VCUG is utilized differently by different specialties. In some centers, adult specialties may order a pediatric VCUG. General pediatricians order VCUG the most with a tendency for misuse in up to 50%. Pediatric urology is not the most ordering specialty of VCUG; however, it utilizes it most appropriately. The noted practice patterns may be improved with awareness of the indications and limitations of the study and with proper referral.
    Language English
    Publishing date 2019-02-28
    Publishing country India
    Document type Journal Article
    ISSN 0974-7796
    ISSN 0974-7796
    DOI 10.4103/UA.UA_124_18
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Burnout of residents: Overview from various medical institutions - A suggested model for improvement.

    Degheili, Jad A / Yacoubian, Aline A / Dargham, Rana Abu / El-Hout, Yaser Z

    Urology annals

    2019  Volume 12, Issue 1, Page(s) 9–14

    Abstract: Background: Burnout is a common issue among residents across the globe. Although several attempts were made to propose better working hours for residents, burnout is still prevalent as depicted by several studies.: Objectives: The aim of the paper is ...

    Abstract Background: Burnout is a common issue among residents across the globe. Although several attempts were made to propose better working hours for residents, burnout is still prevalent as depicted by several studies.
    Objectives: The aim of the paper is to review several worldwide studies related to burnout in residents and propose potential suggestions.
    Methods: The following paper summarizes studies pertinent to burnout in residents from different countries categorized into three main regions: North and South America, Europe, and Middle East. The studies were collected from February 2018 to March 2019.
    Results: Numerous studies across the world have revealed high rates of burnout in residents during the last decades.
    Conclusions: Various awareness and wellness programs, as well as professional counseling sessions, are proposed to help residents overcome burnout.
    Language English
    Publishing date 2019-11-07
    Publishing country India
    Document type Journal Article ; Review
    ISSN 0974-7796
    ISSN 0974-7796
    DOI 10.4103/UA.UA_107_19
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  3. Article: Partial nephrectomy for metastatic renal cell carcinoma: Where do we stand?

    Shahait, Mohammed / Mukherji, Deborah / El-Hout, Yaser

    Indian journal of urology : IJU : journal of the Urological Society of India

    2015  Volume 31, Issue 2, Page(s) 102–105

    Abstract: Nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) offers comparable oncologic results, but a lower risk of chronic kidney disease, when compared with radical nephrectomy. However, there are limited data in the literature examining the safety ... ...

    Abstract Nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) offers comparable oncologic results, but a lower risk of chronic kidney disease, when compared with radical nephrectomy. However, there are limited data in the literature examining the safety of NSS in the setting of metastatic RCC. To evaluate the feasibility of NSS and impact on cancer-specific survival (CSS) in patients with metastatic disease, we performed a systematic review of the literature. There is ample evidence that NSS is feasible in metastatic RCC, with comparable results in terms of CSS compared with radical cytoreductive nephrectomy.
    Language English
    Publishing date 2015-04-16
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 639268-4
    ISSN 1998-3824 ; 0970-1591
    ISSN (online) 1998-3824
    ISSN 0970-1591
    DOI 10.4103/0970-1591.154300
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  4. Article ; Online: Music as an adjunct to combination analgesia for neonatal circumcision: A randomized controlled trial.

    Sharara-Chami, Rana / El-Hout, Yaser / Lakissian, Zavi / Hafez, Bassel / Abi-Gerges, Carine / Fayad, Joe / Charafeddine, Lama / Tazian, Vicky / Tamim, Hani / Zaghal, Ahmad

    Journal of pediatric urology

    2021  Volume 18, Issue 2, Page(s) 184.e1–184.e6

    Abstract: Introduction: Neonatal circumcision is one of the most frequently performed procedures in male infants; it is also particularly painful. In a previous trial, we showed that the combination of Eutectic Mixture of Local Anesthetics (EMLA) + Sucrose + Ring ...

    Abstract Introduction: Neonatal circumcision is one of the most frequently performed procedures in male infants; it is also particularly painful. In a previous trial, we showed that the combination of Eutectic Mixture of Local Anesthetics (EMLA) + Sucrose + Ring Block (RB) was significantly effective in reducing pain during circumcision.
    Objective: In this study, we added music as an adjunct aiming to further reduce the pain scores.
    Study design: This was a double-blinded randomized controlled trial comparing EMLA + Sucrose + RB (Control) to EMLA + Sucrose + RB + Music (Intervention). The trial setting was the normal nursery of a university teaching hospital. One hundred and three healthy newborn males were randomized to each of the intervention and control groups. Babies were videotaped (face and torso) during the procedure for assessment of pain by two blinded and independent reviewers. The primary outcome measure was the NIPS score; secondary outcomes included heart rate, oxygen saturation and crying time.
    Results: The NIPS score of the intervention group (EMLA + Sucrose + RB + Music [2.6 ± 1.6]) was significantly higher than that of the control group (EMLA + sucrose + RB [1.4 ± 0.9]) (p = 0.00). Inter-rater reliability was high (κ .89). The intervention group registered significantly higher mean heart rate (142 bpm) and increased mean crying time (5.44 s) compared to the control group (135 bpm and 1.63s, respectively) (p = 0.01) and (p = 0.00). No adverse events were noted. Delivery music medicine by playing it from an iPad in the procedure room did not reduce pain during circumcision.
    Discussion: There is overwhelming evidence in the literature describing the effectiveness of music on pain management especially in the NICU. However, our results did not align with the general trend; not only did music medicine fail to enhance analgesia but it might have had the opposite effect, further agitating the infants, as indicated by the significantly increased heart rate, crying time and NIPS scores of the participants in the intervention group. Limitations of our study include the fact that this is a single center study and the method of delivering music via iPads instead of noise-canceling headphone.
    Conclusion: Our results showed that music, delivered in this manner, may have increased agitation. We affirm the fact that the combination of EMLA + Sucrose + RB is highly effective for managing pain during circumcision and further reduction of already low scores might not be possible.
    Clinical trial registration: Registry Name: ClinicalTrials.gov; Registration number: NCT04252313; link: https://clinicaltrials.gov/ct2/show/NCT04252313.
    MeSH term(s) Analgesia/methods ; Anesthetics, Local ; Circumcision, Male/methods ; Humans ; Infant ; Infant, Newborn ; Lidocaine ; Lidocaine, Prilocaine Drug Combination ; Male ; Music ; Pain/etiology ; Prilocaine ; Reproducibility of Results ; Sucrose
    Chemical Substances Anesthetics, Local ; Lidocaine, Prilocaine Drug Combination ; Prilocaine (046O35D44R) ; Sucrose (57-50-1) ; Lidocaine (98PI200987)
    Language English
    Publishing date 2021-12-24
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2237683-5
    ISSN 1873-4898 ; 1477-5131
    ISSN (online) 1873-4898
    ISSN 1477-5131
    DOI 10.1016/j.jpurol.2021.12.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6387: Show issues Location:
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  5. Article ; Online: Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial.

    Sharara-Chami, Rana / Lakissian, Zavi / Charafeddine, Lama / Milad, Nadine / El-Hout, Yaser

    Pediatrics

    2017  

    Abstract: Objectives: There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.: Methods: This is a double-blinded randomized controlled trial comparing 3 combination analgesics used ... ...

    Abstract Objectives: There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.
    Methods: This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time.
    Results: Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB (
    Conclusions: During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream.
    Language English
    Publishing date 2017-11-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2017-1935
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  6. Article ; Online: Current status of retrograde intrarenal surgery for management of nephrolithiasis in children.

    El-Hout, Yaser / Elnaeema, Aziza / Farhat, Walid A

    Indian journal of urology : IJU : journal of the Urological Society of India

    2011  Volume 26, Issue 4, Page(s) 568–572

    Abstract: Purpose: To review the current status of retrograde intrarenal surgery (RIRS) for renal stones in children focusing on its indications, outcomes and success in the management of nephrolithiasis.: Materials and methods: Between 1988 and 2009, a ... ...

    Abstract Purpose: To review the current status of retrograde intrarenal surgery (RIRS) for renal stones in children focusing on its indications, outcomes and success in the management of nephrolithiasis.
    Materials and methods: Between 1988 and 2009, a comprehensive PubMed/MEDLINE literature review on RIRS was conducted.
    Results: The available literature is limited and heterogeneous, skewed by favorable results on ureteral stone outcomes. However, recent case series report outcomes comparable to time-honored modalities: percutaneous nephrolithotomy and shock wave lithotripsy. Concerns about urinary tract damage are not substantiated by the yet available intermediate-term follow-up.
    Conclusions: RIRS seems to be an effective modality in pediatric nephrolithiasis management. However, long-term outcomes and comparative prospective randomized studies are awaited.
    Language English
    Publishing date 2011-02-27
    Publishing country India
    Document type Journal Article
    ZDB-ID 639268-4
    ISSN 1998-3824 ; 0970-1591
    ISSN (online) 1998-3824
    ISSN 0970-1591
    DOI 10.4103/0970-1591.74463
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  7. Article ; Online: Editorial comment.

    El-Hout, Yaser / Farhat, Walid A

    Urology

    2010  Volume 76, Issue 1, Page(s) 77

    MeSH term(s) Child ; Cryptorchidism/diagnosis ; Cryptorchidism/surgery ; Humans ; Male ; Palpation ; Scrotum ; Urologic Surgical Procedures, Male/methods ; Urologic Surgical Procedures, Male/standards
    Language English
    Publishing date 2010-07
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2009.12.017
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  8. Article ; Online: Congenital vesicovaginal fistula: spontaneous or forced? Two cases and literature review.

    Zeineddine, Hussein A / Nassif, Joseph / El-Hout, Yaser / Suidan, Fayez / Saleh, Zeina M / Bazi, Tony

    International urogynecology journal

    2014  Volume 25, Issue 9, Page(s) 1167–1172

    Abstract: Introduction and hypothesis: Congenital vesicovaginal fistula is an exceedingly rare entity. There is no consensus regarding the nature and origin of this condition. We report two cases with congenital vesicovaginal fistula and compile previously ... ...

    Abstract Introduction and hypothesis: Congenital vesicovaginal fistula is an exceedingly rare entity. There is no consensus regarding the nature and origin of this condition. We report two cases with congenital vesicovaginal fistula and compile previously reported cases in the English literature. Theories behind the genesis of this anomaly will be briefly presented.
    Methods: We describe the presentation, diagnostic workup, and management of two patients with congenital vesicovaginal fistula. Previously reported cases were retrieved through an extensive English literature review using Medline and PubMed. Cases are tabulated based on the presence or absence of vaginal menstrual outflow obstruction.
    Results: Two women, aged 23 and 17, had had cyclic hematuria since puberty that was perceived as normal menstruation. One woman presented with an inability to have sexual intercourse, and the other with severe cyclic pelvic pain. Diagnostic workup unveiled congenital vesicovaginal fistula and distal vaginal agenesis in both. One had abnormal ureteric insertion, while the other had a history of anomalies unrelated to the urogenital system. Successful surgical correction of fistula was undertaken in both. An English literature review revealed 23 reported cases of congenital vesicovaginal fistula. While 74 % had concomitant menstrual outflow obstruction, the remaining had normal menstruation per vagina.
    Conclusion: Congenital vesicovaginal fistula can present as an isolated anomaly, or associated with complex malformations of a wide spectrum. The presenting symptoms as well as the age at diagnosis vary widely. While the term "congenital" implies its genesis before birth, a congenital vesicovaginal fistula can be a manifestation of faulty embryological development, but also the result of outflow obstruction.
    MeSH term(s) Adolescent ; Female ; Humans ; Vagina/abnormalities ; Vesicovaginal Fistula/congenital ; Young Adult
    Language English
    Publishing date 2014-07-19
    Publishing country England
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1050631-7
    ISSN 1433-3023 ; 0937-3462
    ISSN (online) 1433-3023
    ISSN 0937-3462
    DOI 10.1007/s00192-014-2477-8
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  9. Article ; Online: Pediatric urology training: performance-based assessment using the fundamentals of laparoscopic surgery.

    Brydges, Ryan / Farhat, Walid A / El-Hout, Yaser / Dubrowski, Adam

    The Journal of surgical research

    2010  Volume 161, Issue 2, Page(s) 240–245

    Abstract: Background: Despite the proven utility of laparoscopy in pediatric urology, widespread adoption of the surgical approach has been limited. The Fundamentals of Laparoscopic Surgery (FLS) is a reliable teaching mode for surgeons. Our study objective was ... ...

    Abstract Background: Despite the proven utility of laparoscopy in pediatric urology, widespread adoption of the surgical approach has been limited. The Fundamentals of Laparoscopic Surgery (FLS) is a reliable teaching mode for surgeons. Our study objective was to evaluate the effectiveness of a laparoscopic training course via a performance based assessment of participants' technical skills on the FLS module.
    Materials and methods: The laparoscopic pediatric urology course, administered to 18 fellows, consisted of a 6-h didactic session and a full d practice on a live porcine model. FLS skills were practiced prior to and immediately following the course, and included peg transfer, precision pattern cutting, securing a ligating loop, and intracorporeal suturing. Written exams were used to evaluate participants' cognitive knowledge about laparoscopic procedures. Pretest and post-test performances were compared using paired t-tests. Previous laparoscopic caseload was addressed as a potential predictor of performance using two separate Pearson correlations between total caseload and performance scores.
    Results: Participation in the course led to significant improvements in FLS and written exam scores. Laparoscopic caseload was correlated with pretest performance (R = 0.53, P < 0.05) though this correlation was not significant at post-test (R = 0.41, P > 0.05). However, the improvement from pretest to post-test (i.e., difference score) was significantly related to the participants' pediatric laparoscopic caseload (R = -0.47, P < 0.05).
    Conclusions: Operative experience is instrumental in attaining laparoscopic skills. However, intensive simulation-based training improves technical performance and cognitive knowledge competence, especially for novice trainees. Long-term assessment of trainees is required to ascertain the effectiveness of this approach to laparoscopic training.
    MeSH term(s) Child ; Cognition ; Computer Simulation ; Curriculum ; Educational Measurement ; Hospitals, Pediatric ; Humans ; Laparoscopy/methods ; North America ; Pediatrics/education ; Plastics ; Urology/education
    Chemical Substances Plastics
    Language English
    Publishing date 2010-06-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2008.12.041
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  10. Article ; Online: Functioning metastatic paraganglioma of the urinary bladder in a 10-year-old child.

    El Alayli, Alaeddine / El Amine, Mohammad Ali / El Hout, Yaser / Naffaa, Lena

    BMJ case reports

    2017  Volume 2017

    Abstract: Paragangliomas of the urinary bladder are very rare tumours representing less than 1% of bladder tumours. Preoperative diagnosis is essential to avoid perioperative complications related to catecholamine release. A high index of suspicion should be ... ...

    Abstract Paragangliomas of the urinary bladder are very rare tumours representing less than 1% of bladder tumours. Preoperative diagnosis is essential to avoid perioperative complications related to catecholamine release. A high index of suspicion should be maintained when the classical symptoms of voiding-related paroxysms of headache, palpitation and dizziness are present. We present a rare case of malignant paraganglioma of the urinary bladder in a 10-year-old boy. The patient had the classic presentation. We review the radiological diagnostic tools and findings of this rare entity.
    MeSH term(s) Child ; Cystectomy ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Paraganglioma/diagnostic imaging ; Paraganglioma/surgery ; Treatment Outcome ; Ultrasonography ; Urinary Bladder Neoplasms/diagnostic imaging ; Urinary Bladder Neoplasms/surgery
    Language English
    Publishing date 2017-07-19
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2017-220533
    Database MEDical Literature Analysis and Retrieval System OnLINE

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