The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction.

OBJECTIVE: To report our experience of assessing children with chronic voiding dysfunction (>6 months' duration) using a minimal urodynamic evaluation, and the management of detrusor-sphincter dyscoordination (DSdc) using pelvic floor biofeedback. PATIENTS AND METHODS: From 1994 to 1997, 120 children (mean age 7.5 years) with three predominant and associated symptoms were referred to one urologist; they had nocturnal enuresis (28 children), urge incontinence (42) or urinary tract infection (50). All patients were assessed by urinary culture, renal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flowmetry with sphincter electromyography (EMG) using perineal surface electrodes. If they had urinary tract infection and/or renal dilatation, they underwent voiding cysto-urethrography. In children with DSdc, urinary training with frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory. RESULTS: DSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico-ureteric reflux was detected in 24 patients, associated with DSdc in 10. The reflux resolved spontaneously on antibiotic prophylaxis in six children and after urinary re-education in four. CONCLUSION: A minimal urodynamic evaluation seems to be useful in the diagnosis of DSdc which caused urinary tract infection and/or bladder overactivity. The results with pelvic floor biofeedback were excellent in these children.

[Ambulatory anesthesia in pediatrics. 2-year experience of performance at a day hospital]. / Anesthésie ambulatoire en pédiatrie. Expérience de deux années de fonctionnement d'un hôpital de jour.

Ambulatory pediatric anaesthesia is done within a well-organized medical and surgical structure. The anaesthesia consultation confirms the surgical indications, taking into account certain medical pathologies. 27% of elective surgery is done in day-hospital. The anaesthetic techniques described have been done in children from three weeks to sixteen years of age. Intubation was not an exclusion criterion. The major causes for transfer to the general hospital (2.9%) are given. Anaesthetic complications represent 0.1% of such transfers. Scrupulous respect of the selection criteria, competence of anaesthesiologists and of pediatric surgeons are prerequisites for good results.

[Oxalate lithiasis associated bith abetalipoproteinemia. Report of a case]. / Lithiase oxalique associée à une abêtalipoprotéinémie. A propos d'un cas.

A case of oxalate lithiasis associated with Abetalipoproteinemia is reported. The excessive absorption of dietary oxalate in this patient with fat malabsorption occurs because unabsorbed fatty acids in the bowel lumen combine with calcium ions which would otherwise impair oxalate absorption by forming insoluble calcium oxalate crystals. The medical management include dietary fat restriction and supplements of the fat soluble vitamins A, E and K. The prognostic is poor particularly in the neurological and retinal component of this disease.

[Arguments against routine surgery for acute intestinal intussusception. Apropos of 220 cases]. / Plaidoyer contre l'intervention chirurgicale systématique dans les invaginations intestinales aiguës. A propos de 220 observations.

220 children with intussusception were treated at Rouen Children's Hospital between 1969 and 1981. The patients are separated in four groups according to the treatment: --primary operation without barium enema, --operation after failure of the barium enema, --surgical control after reduction by barium enema, --barium enema alone. This study shows that in the third group, the operation did not demonstrate neither any "lead-point", nor any intestinal damage requiring resection. A "lead-point" or an intestinal lesion have been found only in intussusceptions which had not been reduced by barium enema. Thus, one can conclude that a surgical control is useless when the barium enema is successful. The technique of the enema is described.

[Interest of the sphincteromyectomy in the treatment of idiopathic constipation and short-segment Hirschsprung's disease (author's transl)]. / Intérêt de la sphinctéromyectomie dans le traitement de la constipation idiopathique et des formes courtes de la maladie de Hirschsprung.

During last 10 years, 33 children presenting with a severe constipation (19 of them with subobstruction episodes) have been treated with sphincteromyectomy at ages varying from 3 m. to 13 y. The aetiologic study of the constipation includes a barium enema, a manometric study (for the cases treated since 1975) and a histologic study of the muscular strip obtained during the sphincteromyectomy. The barium enema does not show any specific pattern of Hirschsprung's disease, on the other hand, the manometric study brings more constant arguments to distinguish the idiopathic constipation from the short-segment Hirschsprung's disease. The sphincteromyectomy is done by anal approach (28 times) or by posterior approach (6 times). One patient has had 2 sphincteromyectomies. 14 patients had a Hirschsprung's disease and we find among them 9 very good or good results. 5 failures needed a rectal resection by the Swenson's technique. 19 children had an idiopathic constipation. 2 have not been reviewed. Among the 17 others, we find 11 very good results. No postoperative complications have been observed particularly not any incontinence.