Percutaneous aspiration irrigation drainage technique in the management of septic arthritis in children.

BACKGROUND: Septic arthritis in childhood is a therapeutic emergency. The authors present their experience using an intermediate technique with the advantages of the percutaneous aspiration irrigation drainage: joint aspiration, irrigation, and declivious drainage. METHODS: All children were treated by joint aspiration under fluoroscopic control, large volume irrigation, and declivious nonsuction drainage associated with immobilization and intravenous antibiotics during 8 days to 10 days. The draining system was removed when clinical improvement (namely apyrexia) and the decrease of biological inflammatory response were obtained. A late follow-up phone interview was made for each patient. Fifty-two patients were included in this study, with a mean age of 4.3 years. The most common sites of arthritis were the hip (19 of 52, 36%) and the knee (17 of 52, 32%), but ankle (8 of 52, 15%), shoulder (12%), and elbow (3%) were also involved. RESULT: Apyrexia was obtained after a mean period of 2 days. The mean draining duration was 4.5 days. On the last follow-up visit (at 21 months on average; range, 12-56 months), all patients except one were totally painless and had no limitation of physical activity. CONCLUSION: Percutaneous aspiration irrigation drainage assured very good results in this study population, with rapid clinical and biological improvement and the absence of long-term sequelae. The advantages of this technique include permanent joint access and control of synovial effusions, with only one general anesthesia and minimal iatrogenic morbidity.

Functional ectopic ureter in case of ureteric duplication in children: initial experience with laparoscopic low transperitoneal ureteroureterostomy.

PURPOSE: In this paper, we discuss the value of the laparoscopic ipsilateral ureteroureterostomy for duplication anomalies of the urinary tract in children. MATERIALS AND METHODS: A laparoscopic retroperitoneal ureteroureterostomy was undertaken in 2 children with 3-mm instruments and a 30-degree 5-mm optical trocar. Cystoscopy and stent placement in the recipient ureter was performed at the beginning of each procedure. The end-to-side anastomosis was performed with running 6:0 sutures. The type of procedure, position of operating devices, postoperative stenting, hospital stay, and outcome were recorded; each child had a control ultrasound at 6 months of follow-up. RESULTS: The two operations were performed on girls. Patients were 8 and 18 months of age, respectively. Diagnosis was, in each case, obstructed upper pole ureter, without reflux and with a functioning upper pole. Operative time was 120 minutes. There were no intra- and no postoperative complications. Patients were discharged home after 4 and 7 days. Ultrasound at 6 months after the operations showed an important decrease of the ureterohydronephrosis in one case and a complete disappearance of any dilatation in the second case. Parenchyma of the upper poles were considered as normal. CONCLUSION: Initial results of the minimally invasive ipsilateral ureteroureterostomy were excellent, with a minimal requirement of analgesia and perfect cosmetic results. Long-term follow-up, concentrating on the absence of urinary infection and of destruction of the upper poles, is mandatory.