[Flexible ureteroscope damages. Evaluation of university hospital service equipment]. / Sinistralité des urétérorénoscopes souples. Évaluation du parc matériel d'un service hospitalier universitaire.

OBJECTIVE: To evaluate predictors of flexible ureterorenoscopes breakage and damage of their optical beam. MATERIALS AND METHODS: Retrospective survey, single center on 393 interventions with 4 flexible ureterorenoscopes between January 2009 and March 2013. We analyzed factors linked to patient, pathology and surgical technique. RESULTS: We identified 21 major accidents, a breakage rate of 5.34% and 76 pixels losses in the maintenance of endoscopes and 10 during the procedure. The only statistically significant predictor of loss was the cumulative duration of operating time since the last repair (P=0.04, OR=1.001 [1-1001]). For lesions of the optical beam between the procedures, parameters appearing as significant were the ureterorenoscope model (P=0.01, OR=2.558, 95% CI [1229-5326]), the use of instruments by the working channel: the laser (P=0.02, OR=2.06, 95% CI [1109-3827]), or the use of endoluminal graspers (P=0.007, OR=0.467, 95% CI [0269-0809]). Intraoperatively, the number of open or laparoscopic surgery (P=0.007, OR=3.105, 95% CI [1364-7068]), duration of intervention (P=0.01, OR=1.023, 95% CI [1.006-1041]) and the cumulative duration of intervention (P=0.003, OR=1.001, 95% CI [1-1002]) appeared to be statistically significant. CONCLUSION: The only predictor of loss of equipment under repair was the cumulative duration of operation time. It has not been demonstrated any difference between ureterorenoscopes. It was during the endoscopes disinfection that the majority of optical beam lesions take place.

[Post-surgical septic arthritis of the pubic symphysis]. / Symphysite pubienne infectieuse post-chirurgicale.

The post-surgical septic arthritis of the pubic symphysis is a rare infection, often unrecognized because sometimes it is difficult to diagnose. It should be suspected in the presence of pelvic pain with fever and sometimes lameness or painful radiation to the lower limbs but the symptoms can be misleading. We report 3 cases of post surgical septic arthritis of the pubic symphysis to illustrate it. Differential diagnoses are numerous and additional tests not always specific. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations are essential to substantiate the diagnosis or to guide sampling. The appropriate antibiotic treatment against the identified germ, which is extended at least six weeks, will most often, when started early, allow the healing though pain can persist for several months.