[Varicocele in adolescents. 67 cases]. / Les varicocèles de l'adolescent. Soixante-sept cas.

We examined 67 adolescents aged 11 to 14 years referred for left varicocele. Atrophy of the testes was present in 38 (75%). Several techniques, including laparoscopic surgery were used. The best method appears to be ligation of the spermatic veins via an inguinal approach without touching the artery if possible. Recurrence (5%) is always caused by missing a vein. Growth of the testis occurred in all cases after treatment of the varicocele.

[Testicular ectopy in children. Current practical attitude]. / Ectopie testiculaire de l'enfant. Attitude pratique actuelle.

Testicular descent is a complex mechanism, appearing at the end of gestation, influenced by mechanical and hormonal factors. Surgical therapy should as soon as possible be done, in order to avoid the risk of degeneration and sterility.

[Antenatal screening of uropathies. A 4-year experience, 147 patients]. / Uropathies de dépistage anténatal. 4 ans d'expérience, 147 patients.

We have received 147 patients with an antenatal diagnosis of uropathy confirmed after birth. Surgery during the first 3 months of life was necessary for 78 (54%) of them. The procedures included partial or total exeresis of the kidney in 9 cases, and reconstruction of the excretory pathway in 69 (88%). The renal function is normal in all cases, and one failure of surgery only was noted. Four children with pelviureteral obstruction had infections in spite of the antenatal screening, as did one child with reflux. One child remained with a postoperative urinary infection, which can be attributed to contralateral reflux. In surgery of the renal pelvis, as well as in the reimplantation of thin ureters, no tube was left in place, thus reducing the stay in hospital and the risk of post-operative infection. The children were admitted to hospital with their mothers in 95% of all cases.

Multicenter survey of endoscopic treatment of vesicoureteral reflux in children.

17 centers answered an inquiry on the endoscopic treatment of vesicoureteral reflux. 844 children were reviewed representing 1,290 ureters treated by endoscopic injection of Teflon. The first results in cases of primary or secondary reflux showed a success rate of 82.3%. All authors report low morbidity and excellent tolerance of this technique. In view of the long-term prognosis, these results should be reanalyzed, the median follow-up presently being 1 year. The next logical step should be the development of implant material with a higher biocompatibility but the identical physical properties as Teflon.

[Value of the Hickman catheter in pediatric nephrology]. / Intérêt du cathéter de Hickman en néphrologie pédiatrique.

The Hickman catheter is a single or double lumen catheter made of a silicone polymer; it is introduced surgically into the superior vena cava or the right atrium. The authors have used this catheter in 11 children, aged from 3 to 15 years and weighing from 10 to 40 kg, either for haemodialysis in children without arteriovenous fistula (n = 10), or for plasma exchanges (n = 1). In 5 of the 10 children, an arteriovenous fistula was created while the catheter was being installed. The catheter was left in place for a mean period of 48 days and a maximum period of 5 months. Data from the literature suggests that this instrument can be used for even longer periods. Dialysis was satisfactory in 8 out of 10 cases. No infection or thrombosis of the catheter was observed. The catheter was not perfused between haemodialysis sessions or blood exchanges.

Treatment of neonatal hydronephrosis by malformation of the ureteropelvic junction: interest of percutaneous nephrostomy.

The authors have studied 42 children less than 1 month of age, who had hydronephrosis due to ureteropelvic junction obstruction. Most of them were detected by antenatal ultrasound. Bilateral forms were found in 13 patients. Thus a total of 55 kidneys were involved. Three forms were distinguished. The benign forms (n = 15) were operated. The mild forms (n = 29) must be operated, but not in emergency. Immediate complications (n = 5) and failures (n = 4) are more frequent than in older children. The severe forms (n = 11) are characterized by renal mutation on IVU. In these forms, percutaneous nephrostomy confirms the diagnosis and shows the functional value of the kidney. Only 5 of these 11 children underwent nephrectomy.

Urolithiasis in children. Presenting signs, etiology, bacteriology and localisation.

Based on a personal series of 310 observations, the authors have studied the presenting signs, the etiology, the urinary bacteriology and the localization of the stone in children with urolithiasis. Urinary tract infection is the presenting sign in 55% of the cases, hematuria in 23% and abdominal pain in 20%. Urinary malformation is associated in 26% of cases, whatever the age at diagnosis. The urinary bacteria found in 55% of cases is Proteus. Localization was in the kidney in 228 cases, in the ureter in 71 cases, the bladder in 45 cases and in the urethra in 5 cases.

[Urethral duplication in boys. Apropos of 16 new cases]. / Les duplications uréthrales chez le garçon. A propos de 16 nouveaux cas.

A total of 16 cases of urethral duplication in boys have been treated over a period of 20 years. Applying the classification described by Innes Williams cases could be divided into: epispadial urethral duplications, hypospadial duplications, spindle urethras, bifid urethras with an accessory preanal branch, and finally collateral duplications. The 16 cases reported were an epispadial double urethra (3 duplicated and 2 bifid) in 5 cases, a hypospadial duplication (4 bifid and 6 blind urethras) in 10 cases, and a bifid urethra with an accessory preanal branch in one case. Not one of the other forms was observed. Treatment of epispadial double urethras consisted mainly of almost total ablation of the supernumerary urethra with freeing of the corpus cavernosum when dorsal incurving developed during erection. The blind forms associated with the hypospadias in hypospadial duplications have no incidence on treatment. In the incomplete forms, treatment is based on four principles: the impossibility of using the superior urethra which extends to the end of the penis, as it is to narrow, implying its opening up to the region facing the hypospadial meatus and the transformation of this incomplete urethral duplication into a single orifice hypospadias; endoscopic resection of the mucosal folds producing a valve effect at the junction between the 2 urethras; the need to straighten an angled penis; and finally the performance of a urethroplasty using the same rules as for surgery of hypospadias. Treatment of bifid urethras with accessory preanal branches depends on the condition of the principal urethra. When this is normal it is sufficient to excise the accessory branch.(ABSTRACT TRUNCATED AT 250 WORDS)

[The risk factors of bladder tumors stage "A". Description of a new parameter (author's transl)]. / Les facteurs de risque des tumeurs de vessie au stade A. Description d'un nouveau paramètre.

199 cases of carcinoma of the bladder stage A were reviewed with a follow-up from 5 to 15 years. Some "factors of risk" can be deducted from this study. The first is the depth of the invasion of the submucosa when it can be specified. If the superficial part only is invaded (these tumors are called A1) the understaging is less important and the survival rate is much better than when the chorion is totally invaded (called A2). The grade of the tumor is also significant, grade III having a more favorable prognosis than grade IV. The topography of the tumor influences the prognosis: the worse are the tumors of the bladder neck or of this trigone. The other factors of risk are: the rapidity of recurrences, the volume and the number of the tumors: when they are big and multiple, the prognosis is particularly bad, the type of differenciation: the cylindric tumors are worse than the urothelial or epidermoid.