[Urethral fistulas after surgical treatment of hypospadias. Apropos of a series of 74 cases]. / Les fistules de l'urètre après traitement chirurgical d'hypospadias. A propos d'une série de 74 cas.

OBJECTIVE: To analyse the causes of fistulas following urethroplasty procedures and the principles of their surgical treatment. MATERIAL AND METHODS: 74 fistulas were treated: 6 were on the glans, 17 coronal, 33 on the distal shaft, 6 midshaft, 8 proximal shaft and 4 penoscrotal. More than 75% underwent a simple closure or invagination of the fistula into the urethra, often without urinary diversion. A second-stage urethroplasty was necessary in 15 cases. RESULTS: The initial success rate was 72.5%. Results obtained with simple closure or invagination were better than extensive surgery (50% failure rate). Seventy two percent of these fistulas without urinary diversion were treated successfully as compared to 53.8% of those which had required a catheter. CONCLUSION: Of all the complications of hypospadias surgery, fistulas are in most cases the easiest to resolve, provided that some fundamental rules are respected: a minimum of 6 month between both procedures, previous treatment of any concomitant urethral stenosis, use of a tourniquet and loops magnification, and an additional layer of interrupted subcutaneous sutures. A haemostatic dressing reduces the tension of the sutures. An urinary diversion is only necessary for larger fistulas which require a second-stage urethroplasty.

[Endoscopic treatment of vesicorenal reflux in children: short- and long-term results of polytetrafluoroethylene (Teflon) injections]. / Traitement endoscopique du reflux vésico-rénal chez l'enfant: résultats à court et à long terme des injections de polytétrafluoroéthylène (Téflon).

OBJECTIVE: To retrospectively evaluate the short-term and long-term efficacy and safety of endoscopic treatment of vesicorenal reflux in children by polytetrafluoroethylene injection, based on the largest series published in the literature. MATERIAL AND METHODS: Six hundred and fifty ureters in 402 children were by subureteric injection of polytetrafluoroethylene from 1986 to 1993. The short-term results were evaluated one month and one year after treatment by physical examination, urine culture, bladder and renal ultrasonography and retrograde cystography. The long-term results were evaluated with a mean follow-up of 116 months by physical examination, renal ultrasonography, questionnaire for the patient's family and urine culture. RESULTS: 86.6% refluxing ureters in 82.1% of children were cured after endoscopic treatment. No serious short-term complications were observed. In the long-term, 97% of children never presented an episode of pyelonephritis. Ultrasonographic assessment did not reveal any dilatation of the upper urinary tract, no any suspicious lesions of the bladder wall. Continuing reflux nephropathy due to chronic pyelonephritis was observed in 4.4% of treated kidneys, despite satisfactory correction of reflux. No local complications related to the biomaterial and no signs suggestive of distant diseases induce by migration of Teflon particles were observed. No malignant degeneration was reported. CONCLUSIONS: Review of this series demonstrates the short-term efficacy and long-term maintenance of the good results of endoscopic treatment of reflux. No local complication and no complications due to migration of Teflon were observed in this series. This procedure avoided the need for conventional ureteric reimplantation in 92% of treated children.

[Endoscopic treatment of vesicorenal reflux in children. Five-year assessment of the use of Macroplastique]. / Traitement endoscopique du reflux vésico-rénal chez l'enfant. Bilan de cinq ans d'utilisation de Macroplastique.

OBJECTIVE: To compare the results of endoscopic treatment of vesicorenal reflux by Macroplastique implantation versus Teflon implantation. MATERIAL AND METHODS: 297 children with 454 refluxing vesicorenal units were treated by endoscopic implantation of Macroplastique (Rplasty)-A.B.S.: 385 cases of primary reflux and 69 cases of secondary or associated reflux. All children were reviewed by ultrasound and cystography 6 weeks and 1 year after implantation. RESULTS: Regardless of the aetiology and the grade, reflux resolved in 91.2% of children (93.3% of ureters). Complications such as ureteric stasis were rare (3 cases). 161 children (253 ureters) were reviewed 1 year after treatment: reflux had recurred in 8.7% of patients. CONCLUSION: Although the mean quantity implanted was lower with Macroplastique, the results appeared to be better than those obtained with Teflon (bases on a previous series of 402 children: cure for 87.1% of ureters and 85.7% of children). The advantages of Macroplastique compared to Teflon include the less liquid consistency, the absence of retraction of the product and the presence of larger microparticles without any local or distant inflammatory reaction.

A study of risk factors for hypospadias in the Rhône-Alpes region (France).

OBJECTIVE: Hypospadias is one of the most common congenital urogenital malformations in males with a significantly increasing incidence over the past 20 years. The causes of this insufficient virilization of the genital tubercle are essentially unknown. SUBJECTS AND METHODS: A hospital-based controlled study was realized with 225 hypospadias cases at Debrousse Hospital, Lyon, using a detailed questionnaire completed during a consultation with the patients' parents and those of controls of the same age. The chi(2), the P-value, the odds ratios and the 95% confidence interval were assessed. RESULTS: Hypospadias was found to be positively associated with genetic factors (as defined by the presence of other case(s) in the family in one case in four) and with neonatal low birth weight, fair-haired boys, maternal history such as viral infection during the first trimester, order of parity, toxaemia of pregnancy, delivery modality such as caesarean section, and environmental pollution. CONCLUSIONS: These results show that aetiological factors of hypospadias are likely to be related to three main fields which interact: genes, the placenta and environmental factors.

A new technique of bladder enlargement and continent urinary diversion using the ceco-appendicular unit.

The authors developed a new technique using the cecum with in-situ appendix to simultaneously achieve bladder enlargement and continent urinary diversion (CUD) in five cases of neuropathic bladder or serious complications of abdominopelvic trauma. The cecoplasty provides a large-capacity, low-pressure reservoir; the submucosally-embedded appendix gives complete continence with 3 to 5 intermittent catheterizations daily. It is an alternative to the Mitrofanoff principle when bladder augmentation and CUD are necessary, and easier to achieve when faced with a neuropathic bladder where the thickness of the detrusor makes appendicular implantation difficult.