Mini-percutaneous nephrolithotomy: Is smaller better for kidney stones in patients with neurogenic bladder?

INTRODUCTION: Patients with neurologic bladder are at an increased risk for urolithiasis, and currently, data on mini-percutaneous nephrolithotomy in this population are limited. Our objective was to compare mini (15F)-percutaneous nephrolithotomy, standard (24F)-PCNL and flexible ureteroscopy in terms of efficacy and safety in treatment of kidney stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: We conducted a retrospective monocentric study in our neuro-urological referral centre. All consecutive patients with NLUTD and a cumulative size of renal calculi greater than 15mm or 10mm in the lower calyx, who had extraction surgery between 2005 and 2020, were included. The primary endpoint was the one-session stone-free rate (SFR) at 3 months on a CT scan. The secondary endpoints were complication (Clavien-Dindo grading system), operative time, blood loss and length of hospital stay. RESULTS: We performed 76 standard PCNL (sPCNL), 46 flexible ureteroscopy lithotripsy (fURL) and 25 miniaturized PCNL (mPCNL). The one-session SFR was 37.5% for the mPCNL group, 38.2% for the sPCNL group and 37% for the fURL group with no significant difference between the three procedures (P=0.99). Early complications, blood loss and transfusion rates were lower in the mPCNL group than in the sPCNL group (P=0.047) and comparable to fURL group. The final SFRs after a second intervention for mPCNL, sPCNL and fURL were 48%, 61.8% and 63%, respectively (P=0.67). CONCLUSION: The efficacy of mPCNL in patients with NLUTD was not different from other techniques, but a significantly lower rate of complications than sPCNL was observed. LEVEL OF PROOF: 3.

Restoration of thumb opposition (opponensplasty).

The authors review the therapeutic principles that must be applied when restoring the thumb opposition surgically. Among the many surgical techniques, five are featured: transfer of the flexor digitorum superficialis of the third or fourth finger, transfer of the extensor indicis proprius, transfer of the palmaris longus, translocation of the flexor palmaris longus tendon, transfer of the extensor pollicis longus. After summarizing the procedures, they emphasize the practical points that must be respected. This surgery, which cannot restore sensitivity, requires a precise assessment of the patient's wishes and information on what can be really expected.

New technique of robot-assisted laparoscopic artificial urinary sphincter implantation in female by a posterior approach with intraoperative cystoscopic monitoring.

PURPOSE: To report the early experience of a modified technique of robot-assisted artificial urinary sphincter (AUS) implantation in female, with a posterior approach to the bladder neck and intraoperative real-time cystoscopic monitoring. METHODS: Retrospective monocentric study included all consecutive female who underwent a primary robot-assisted AUS implantation between 2017 and 2019. Real-time intraoperative cystoscopic monitoring was carried out to check the correct level of the dissection and to avoid any injury during bladder neck dissection. Perioperative and intraoperative data, functional outcomes and complications were assessed. Continence was defined as 0 to 1 pad per day. RESULTS: Twenty-four patients were included, the median age was 66 years, 23/24 (96%) had previous SUI or prolapse surgery. Two conversions to open surgery and 2 modifications of the surgical technique with anterior dissection of the bladder neck were required due to major vesicovaginal adhesions. Overall, 20 patients underwent the robotic posterior approach. Eleven intraoperative complications in 10 patients (50%) occurred, including 7 bladder injuries 4 vaginal injuries, without the need to stop the procedure. The median hospital stay was 3 days (2-7). One AUS was removed at 1 year due to vaginal erosion. At last follow-up (median 26 months (22-36)), 95% of the devices were in place and activated and the continence rate was 84%. CONCLUSIONS: Early functional results of robot-assisted AUS implantation with a posterior approach to the bladder neck and intraoperative cystoscopic monitoring are promising despite the high rate of intraoperative complications due to previous surgeries. Further evaluation of this technique is required.

Results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist at a mean 5 years' follow-up.

Management of severe joint involvement in rheumatoid wrist is controversial. The gold-standard is total wrist fusion, but total wrist replacement offers a motion-conserving alternative. The purpose of this study was to present the results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist. We performed a retrospective review of 28 arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. Mean follow-up was 64 months. We measured range of motion, grip strength, and pain (on VAS). Function was evaluated preoperatively and at last follow-up with the DASH and PRWE scores. Mean range of motion in flexion-extension was maintained while mean inclination and rotational range of motion showed significant improvement. Mean grip strength increased from 10 kg to 17 kg. Mean pain score decreased from 6/10 to 2/10. Mean PRWE and QuickDASH scores decreased from 62/100 to 25/100 and from 62/100 to 36/100, respectively. Three patients underwent early reoperation to reposition a dislocated implant. No implants had to be removed. Amandys® pyrocarbon arthroplasty is a reliable alternative to total fusion or total replacement in rheumatoid wrist. Indications must be limited to well-aligned wrists with competent capsule-ligament structures.

[Acute renal failure of the donor in encephalic death: A real contraindication to kidney transplantation?] / L'insuffisance rénale aiguë du donneur en mort encéphalique : une réelle contre-indication à la transplantation rénale ?

INTRODUCTION: The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation. MATERIALS AND METHODS: All of the transplants performed in two university hospitals between 2010 and 2017 were analyzed retrospectively. All patients who underwent single kidney transplant from a brain-dead donor with acute renal failure (ARF) were included in this study. ARI was defined here by a decrease over 50 % of glomerular filtration rate (GFR) to a threshold below 45mL/min/1.73 m2 at the time of kidney procurement. Kidney graft survival, incidence of delayed graft function (DGF) and the GFR at 12 months were analyzed. Analysis of kidney transplant survival based on pre-implantation biopsies was additionally done. RESULTS: One hundred and sixty four patients were transplanted with a kidney from donor with ARF during the selected period. At the admission in ICU the average GFR was 67,7±19mL/min/1,73m2. At the time of donation, the average age of donors was 56.4±17.7 years, the GFR was 33.7±8.0mL/min/1.73 m2 16 % of donors were anuric. Cold ischemia time (CIT) was 16.8±5.0hours. The average age of recipients was 55.6±14.1 years. 81 % of the cases were primary transplants. Graft function took place within 7.8±9.4 days after transplantation. There were two non-primary functions (PNF). One hundred and fifty two patients (93 %) had a functional graft at 12 months. The mean GFR at 12 months was 46.8±20.1mL/min/1.73 m2 and 122 patients (73 %) had a GFR greater than 30mL/min/1.73 m2. Seventy-one percent of preimplantation biopsies revealed acute tubular necrosis (ATU); no cortical necrosis was observed. Survival of theses grafts was 85 %, comparable to the total population of study (P=0,21) CONCLUSION: The acute renal failure of the brain-dead donor should not alone be systematically a contraindication to harvesting and kidney transplantation.

Arthroplasty of the proximal interphalangeal joint with the Tactys® modular prosthesis: Results in case of index finger and clinodactyly.

There are various surgical solutions for arthrosis of the proximal interphalangeal (PIP) joint: arthrodesis or denervation. Clinodactyly that is major and the index fingers are traditional contraindications for PIP arthroplasty prostheses. The recurrence of clinodactyly with ligament imbalance and mechanical complications are known complications. The purpose of our study was to evaluate the objective and subjective clinical results and radiological complications of Tactys® prostheses on the PIP joint of the index fingers or with clinodactyly of more than 5° in the other fingers. Two surgeons have implanted 35 total gliding modular Tactys® prostheses in 29 women and 3 men since 2010. The indications for surgery were arthrotic and painful PIP joints. Average pre-op clinodactyly was 7.03° (5-30°) with ulnar deviation (29 cases). Eleven index fingers presented with average clinodactyly of 14.2° (10-20°). The digits operated on were as follows: 13 index fingers, 14 middle fingers, 5 ring fingers and 3 little fingers. Arthrosis was primitive in 23 cases, post-traumatic in 6 cases and rheumatoid in 6 cases. The average age of patients undergoing surgery was 63.7 years (40-85). Objective (mobility, strength, index finger exclusion, scores, clinodactyly) and subjective (patient satisfaction, pain) functional results were collected by a neutral and independent observer, as were radiological complications. With an average follow-up of 2.6 years (1-6.3), the range of motion in all digits improved by 5.4° on average (55.5-60.8). The improvement in range of motion in the index fingers was 4.5° (57-61.5). Clinodactyly in all fingers was corrected by 1.36° (0-20). In the index fingers, average clinodactyly was 1.3° (0-10). The pinch strength in all PIP joints improved significantly from 2.3 kg (0.5-5) to 3.7 kg (1-8). On the PIP of the index fingers, the pinch strength had increased significantly from 2.5 kg (1-4) before surgery to 3.8 kg (1-7.5) post-op. Functional scores improved: PRWE (from 55.36 to 26.7/100), Quick DASH (from 54.6 to 30.5/100). Patient satisfaction was excellent in 15 cases, good in 8 cases, average in 10 cases, poor in 2 cases. The average VAS Pain Score improved from 5.6 to 1.45. We found 3 major complications requiring surgery: 2 stiffening and 1 mechanical loosening with secondary arthrodesis. Five patients presented with non-troublesome, reducible swan neck deformity and one algodystrophy. A gliding, fixed Tactys® prosthesis allowed us to restore ligament balance and to optimally rebalance the periarticular structures. The improvement in range of motion and the correction of clinodactyly was maintained over time. Total arthroplasty of the PIP with a Tactys® is no longer a formal contraindication for the index fingers and in cases of clinodactyly of more than 5°.

Evaluation of a shape memory staple (Qual®) in radial shortening osteotomy in Kienböck's disease: A retrospective study of 30 cases.

The QUAL® (Memometal, Stryker) device is a shape memory staple used for bone fixation during distal radius shortening osteotomy in the context of Kienböck's disease. The present study is a retrospective, single-center and multisurgeon study of 30 patients with a mean follow-up of 8 years. Clinical criteria (range of motion (ROM), strength, pain and functional score) and radiographic data (ulnar variance, distal radius articular surface inclination, Lichtman stage, carpal height and bone healing) were evaluated pre- and post-operatively. We found satisfactory results with the mean grip strength of 22 kg/F before surgery and 24 kg/F after surgery. The mean ROM was 88° preoperatively and 82° postoperatively and the mean ulnar deviation was 23° preoperatively and 21° post-operatively. There was no change in radial deviation and pronation-supination after surgery. The average ulnar variance was 1 mm before surgery and 0.2 mm after surgery. The inclination of the distal radius articular surface on lateral and anteroposterior views and the mean carpal height were similar to the pre-operative ones. There was no delay in bone healing. The mean pain score was 2 at rest on a visual analogue scale after surgery. Seven patients experienced an increase in their Lichtman stage at the follow-up, and two patients were waiting for conversion to a non-conservative surgical treatment. Seven staples were removed postoperatively. Seventy-eight percent of patients returned to work after 3 months on average. Seventy-five percent of patients were at least satisfied with the outcome of their surgery. The QUAL® staple is a reliable option for fixation during shortening osteotomy of the radius in Kienböck's disease.

Adaptive Proximal Scaphoid Implant (APSI): 10-year outcomes in patients with SNAC wrists.

Radioscaphoid arthroplasty with the Adaptive Proximal Scaphoid Implant (APSI®) is an attractive treatment alternative in the short and medium term for patients with early scaphoid non-union advanced collapse (SNAC) wrist. The purpose of our study was to determine the long-term outcomes of this implant in SNAC wrists. All patients who received the implant from October 2002 to October 2010 were included. A clinical and radiographic study was performed. Our case series included 39 patients, of which 33 were contacted, with a mean follow-up of 10 years (5.8-13.4). Most of the patients had stage-1 SNAC wrist (95%). There were nine complications (27%), seven of which required reoperation: implant dislocation (44%) or progression of the carpal degeneration (33%). Ninety-six percent of patients contacted were satisfied or very satisfied with their surgery (although 21% needed a second surgery) with a Mayo Wrist Score of 80/100 and a Patient-Rated Wrist Evaluation of 17.5/100. Wrist strength was 86% of the contralateral side. Flexion-extension range was 101° and pain assessed using a visual analog scale was at 1.2 (0-6). We report satisfactory and lasting results with the APSI®, similar to those of scaphoid excision with four-corner fusion and proximal row carpectomy. Hence, the APSI® is a reliable alternative for treating osteoarthritis in SNAC wrists.

Retrospective study of two fixation methods for 4-corner fusion: Shape-memory staple vs. dorsal circular plate.

The purpose of this study was to compare the results of two groups of patients with four-corner fusion, one group fixed with shape-memory staples and the other with locked circular plates. This retrospective study compared 52 wrists operated for scaphoid excision and four-corner fusion between 2005 and 2011. The arthrodesis was ensured by a shape-memory quadripodal staple (4Fusion(®), Memometal™) in 37 cases and a locking dorsal circular plate (Xpode(®), Biotech Ortho™) in 15 cases. In the staple group, the mean age was 58.5 years and the average follow-up was 4.3 years. In the circular plate group, the mean age was 58.6 years and the average follow-up was 3.1 years. Pain, range of motion, grip strength, functional scores (QuickDASH and PWRE), fusion of the midcarpal joint, complications (implant fracture and reoperation) and patients' satisfaction were used as outcome measures. There was no pain in 43% of patients in the staple group and 40% of patients in the circular plate group at the follow-up; range of motion and functional scores were similar in both groups. Seventy-five percent of patients in the staple group were satisfied or very satisfied versus 60% in the circular plate group. The implant broke in 24.3% of cases in the staple group and 60% in the circular plate group. Reoperation was needed in 18% of the staple cases and 14% of the plate cases. There was no difference between the implants in terms of pain, range of motion, functional scores and patient satisfactory. The implant fracture rate in the plate group was high. This study brings into question implant reliability for the four-corner fusion procedure.

Amandys(®) implant: novel pyrocarbon arthroplasty for the wrist.

OBJECTIVES: Post-traumatic, arthritic or degenerative destruction of the midcarpal and radiocarpal joints are difficult to treat. A new arthroplasty with a free interposition pyrocarbon implant, Amandys(®), is proposed for the treatment of extensive destruction of midcarpal and radiocarpal joints. Preliminary results are reported. METHODS: The prospective series included 25 patients, 15 males and 10 females with a mean age of 60. The indications were degenerative, post-traumatic or rheumatoid destruction of the wrist. Sixty percent of the patients had already had surgery on their wrist before the operation. The mean follow-up was 24months. RESULTS: Three patients had a reoperation: two for a repositioning of the implant and one for a styloidectomy. At the last follow-up, the mean grip strength was 16kg (51% of the contralateral side), the mean range of motion in flexion-extension was 68°. Mean strength and range of motion did not change significantly with the operation. Pain and function showed significant improvement. The mean pain score decreased from 6.7/10 to 3.7/10 postoperatively. The mean PRWE score decreased from 61/100 to 32/100.The mean QuickDash score decreased from 63/100 to 36/100. Ninety-six percent of the patients were satisfied or very satisfied. No dislocation or subsidence of the implant was noticed. CONCLUSIONS: This minimally invasive pyrocarbon interposition increases the possibilities for the treatment of extensive articular destructions of the wrist. Indications must be limited to a well-aligned wrist with competent capsuloligamentous structure. This new arthroplasty is a reliable alternative to other surgical options, which are more radical or invasive such as total arthrodesis or total wrist prosthesis.

Treatment by collagen conduit of painful post-traumatic neuromas of the sensitive digital nerve: a retrospective study of 10 cases.

OBJECTIVES: The purpose of this retrospective study was to report the results of surgery in painful post-traumatic neuromas of the digital nerves treated by collagen conduits after excision of the neuromas, when two stumps were available. METHODS: We retrospectively reviewed all patients operated on for painful neuroma in our institution and having undergone repair with collagen conduits. Their files were retrieved by a coding file (CCAM version 10). Ten patients involving nine digital nerves and one common digital nerve were included. Primary outcome data points were static two-point discrimination, Semmes-Weinstein monofilament testing, Quick-Dash outcome survey scores, Cold Intolerance Symptom Severity (CISS) score and recurrence of pain at final follow-up. We set up a minimum follow-up period of 6 months after surgery. RESULTS: The patients' average age was 30 years. The average follow-up duration was 11.8 months. Five patients had excellent or good results (50%) at static two-point discrimination testing. Semmes-Weinstein monofilament testing results were full, diminished light touch or diminished protective sensation in nine digits (80%). The average Quick-Dash survey score was 19.3. The average CISS score was 27.8. There was no recurrence of pain. CONCLUSIONS: Our findings indicate that collagen conduit is an effective treatment for post-traumatic painful neuromas of digital nerves and common digital nerves.

[Dorsal cutaneous adipofascial flaps of long fingers]. / Les lambeaux cutanés a pédicule adipofascial de la face dorsale des doigts longs.

We report a series with the adipofascio cutaneous flap of the dorsal aspect of long fingers used with an anterograde or retrograde pedicle. Thirty flaps were performed in 29 patients with a mean age of 43 years, 16 cases in emergency and 13 cases secondary for the treatement of traumatic sequelae. The adipofascial pedicle was retrograde for 22 flaps and anterograde for 8 flaps. The donor site was adjacent of the cutaneous defect in 21 cases or at a distance in 9 cases. Transcient veinous congestion was observed in 2 cases. No necrosis was reported. A second surgery of plasty was performed in 1 case for a cutaneous bulk. The quality of the cutaneous coverage gave any functional discomfort and was evaluated very satisfying. These flaps have an important adaptabily of utilization depending on the localisation and the size of the cutaneous defect as well as the quality of its surrounding skin. The homodigital feature of these flaps avoids the disadvantages of the dorsal hand flaps or the heterodigital flaps. Due to their anastomotic vascularisation, these flaps are reliable and therefore can be recommended for the treatment of dorsal cutaneous defects of long fingers less than 2.5 cm.