Moral and ethical issues in living-donor liver transplant in Egypt.

OBJECTIVES: Since brain-death criteria are not accepted in Egypt, only organs acquired from living donors can be used for transplant. Our objective was to highlight the ethical issues raised by living-donor liver transplant. MATERIALS AND METHODS: The study was conducted by reviewing publications from centers performing living-donor liver transplant in Egypt and by consulting with a group of experts in the fields of liver transplantation, clinical ethics, and religious scholarship. RESULTS: The first successful living-donor liver transplant in Egypt was performed at the National Liver Institute in 1991; however, this program did not continue because of poor early results. In August 2002, transplants began at Dar-Al-Foaud Hospital; since then, almost 500 cases of living-donor liver transplant have been performed at 9 centers. Although the donor risk is estimated to be low, 2 donors died (0.4%). The ethical principle that best applies to living-donor liver transplant is primum non nocere (first, not to harm), as the donor derives emotional benefit fromdonation and the opportunity to save a life. It is important to stress that the alternative to living-donor liver transplant in Egypt is not deceased-donor liver transplant. There are no doubts that this is a beneficial procedure for the recipient with acceptable risks to the donor. CONCLUSIONS: It is ethically appropriate to perform liver transplant using living donors.

Inverted ureteral nipple as antireflux technique in surgical management of bilharzial ureteral strictures.

OBJECTIVES: To present our initial clinical experience with the technique of inverted nipple ureteroneocystostomy in patients with dilated bilharzial ureters. METHODS: A total of 36 patients with obstructed dilated bilharzial ureters (56 ureters) underwent inverted nipple ureteroneocystotomy after resection of the obstructed segment. Postoperatively, the patients were invited for follow-up at 3 and 6 months and yearly thereafter. At the first follow-up, urinalysis and culture examinations, serum creatinine measurement, ultrasonography, intravenous urography, or computed tomography, and voiding cystourethrography were performed. The mean follow-up was 32 months (range 16-52). RESULTS: Symptomatic and radiologic improvement occurred in all patients, except for 2, and was sustained in all cases throughout the follow-up period. No reflux was demonstrated on static or voiding cystography in any patients. Recurrent postoperative hydronephrosis occurred in 2 reimplants (3.5%) owing to obstruction at the ureterovesical anastomosis. An episode of acute pyelonephritis requiring hospitalization and treatment with intravenous antibiotics occurred in 1 patient within the fist 6 months postoperatively. Mild reflux was subsequently demonstrated on voiding cystography. CONCLUSIONS: The new technique of inverted nipple ureteroneocystostomy is suitable for reimplantation of dilated bilharzial ureters. Additional studies with a larger number of patients and longer follow-up are necessary to confirm these results.

Outcome of treatment of anterior vaginal wall prolapse and stress urinary incontinence with transobturator tension-free vaginal mesh (prolift) and concomitant tension-free vaginal tape-obturator.

Objective. It is to assess the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O) system as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI). Patients and Methods. Between December 2006 and July 2007, 20 patients with anterior genital prolapse and voiding dysfunction were treated with the transobturator tension-free vaginal mesh (Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O). Sixteen patients had stress urinary incontinence and 4 patients were considered at risk for development of de novo stress incontinence after the prolapse is repaired. All patients underwent a complete urodynamic assessment. All the patients underwent pelvic examination 4-6 weeks after the operation, and anatomical and functional outcomes were recorded. Results. Twenty cystocoeles were repaired: 6 grade II, 12 grade III, and 2 grade IV. There were no vessel or bladder injuries. Eighteen patients had optimal anatomic results and 2 patients had persistent asymptomatic stage I prolapse. Conclusion. These preliminary results suggest that Prolift system offers a safe and effective treatment for female anterior vaginal wall prolapse. However, a long-term followup is necessary in order to support the good result maintenance.