Pediatric urinary incontinence: evaluation of bladder wall wraparound sling procedure.

PURPOSE: In 1996 a surgical procedure for sphincter deficiency was reported in patients with neurogenic urinary incontinence. To our knowledge we report the first series that assesses this procedure since it was initially described. MATERIALS AND METHODS: Seven female and 7 male patients with spinal dysraphism and neurogenic intrinsic sphincter deficiency underwent surgery between 1997 and 2005. All patients had an associated poorly compliant or small capacity bladder. Patient age ranged from 8 to 22 years (mean 14) and all patients presented with persistent urinary incontinence despite intermittent catheterization and pharmacotherapy. Evaluation was based on clinical examination, as well as preoperative and postoperative urodynamic assessments. The surgical procedure involved wrapping a pedicle strip of anterior bladder wall around the bladder neck and fixing it on the pubic symphysis. Bladder augmentation cystoplasty was also routinely performed during the same procedure. RESULTS: Of 14 patients 13 were completely dry and 1 had stress incontinence. Followup was 2 to 8 years (mean 5). Postoperative urodynamic evaluation showed a maximum urethral pressure increase of 40%. We also observed an increase in bladder capacity of 105% and improved bladder compliance (7 ml/cm H(2)O preoperatively vs 35 ml/cm H(2)O postoperatively). CONCLUSIONS: The bladder wall wraparound sling procedure provides excellent results for continence in association with bladder augmentation.

[Multilocular cystic nephroma in an adult: diagnostic and therapeutic strategy]. / Néphrome kystique multiloculaire de l'adulte: stratégie diagnostique et thérapeutique.

The authors report two clinical cases of cystic nephroma in adults observed in the department over the last 10 years. The nonspecific clinical findings and the poor contribution of imaging examinations make this rare disease difficult to diagnose. Only histological examination can confirm the diagnosis and eliminate multilocular cystic renal carcinoma or necrotic pseudocystic carcinoma. Based on a review of the literature, the authors emphasize recent pathophysiological and immunohistochemical data that could improve the management of this benign disease, in which malignant transformation is also possible.

[Lomboscopic surgery for renin-secreting tumour]. / Traitement d'une tumeur a rénine par lomboscopie.

Renin-secreting tumour is a rare, benign entity, responsible for hypertension due to secondary hyperaldosteronism. It must be treated surgically. In the light of a review of the literature, the authors report the first published case of resection of a juxtaglomerular tumour of the kidney by laparoscopic partial nephrectomy using an ultrasound scalpel.

[Can transobturator tape for urinary incontinence cause complete urinary retention?]. / La bandelette trans-obturatrice pour incontinence urinaire peut-elle exposer a une rétention d'urine complète?

The surgical management of stress urinary incontinence has been revolutionized with the development of minimally invasive suburethral tape techniques, which ensure a high continence rate by means of a rapid procedure with a short hospital stay. Although morbidity and adverse effects are uncommon, they must be kept in mind in order to adopt an appropriate strategy designed to prevent their development. Urinary retention is the most frequent postoperative complication of retropubic tape. The recent transobturator tape technique modifies the location of the tape with an angulation more close resembling that of fascial support tissues, thereby decreasing the theoretical risk of retention. The authors report the first case of complete urinary retention and discuss the mechanism and therapeutic strategy.