Management of long ureteral stenosis: Alternatives to indwelling ureteral stents.

OBJECTIF: Evaluate kidney autotransplantation (KAT) and ileal ureter substitution (IUS) practice and outcome as alternatives to indwelling ureteral stents for the management of long ureteral stenosis (US). MATERIAL: We included all patients treated for US with KAT or IUS in 5 French university urology centers between 2010 and 2018. We excluded US due to urothelial carcinoma. Primary endpoint was the preservation of ipsilateral kidney and renal function without any urinary diversion. RESULTS: 22 patients were treated with KAT (n=8, 36.4%) and IUS (n=14, 63.6%). Mean US length was 4.6cm and 6cm (P=0.52) in KAT and IUS groups respectively. US etiologies were lithiasis, iatrogenic, retroperitoneal fibrosis or extrinsic compression. US level was varied. The surgery was described as difficult because of peritoneal adhesions or major peri-ureteral fibrosis. Mean operating time and hospital stay were 336 and 346minutes (P=0.87) and 8 and 15 days respectively (P=0.001). Postoperative complications were mostly Clavien ≤2 (n=17, 77.3%). Revision surgery was required in the KAT group in 3 cases (37.5%), for textiles, renal vein thrombosis and anastomotic leak, none in the IUS group. The mean follow-up was 15.7 months. All but one (in the KAT group) ipsilateral kidneys were preserved, without renal function impairment (Δcreat +2.1 vs. +2.4µmol/l respectively, P=0.67), nor urinary diversion. CONCLUSION: KAT and IUS are safe alternatives whose indication depends on surgeons expertise. Our study pointed out the scarcity of this practice suggesting the need to refer patients to expert centers. LEVEL OF EVIDENCE: 3.

[Plaque incision and Tachosil graft in Peyronie's Disease]. / Incision de plaque et greffe de Tachosil chez les patients atteints d'une maladie de Lapeyronie.

INTRODUCTION: Surgery is a treatment for correction of penile curvature in Peyronie's disease. Partial plaque excision and grafting is recommended for severe and complex curvature. METHODS: Patients with stable penile curvature who underwent a partial plaque excision and grafting between January 2017 and April 2018 were retrospectively included. The graft was realized using a self-adhesive collagen fleece (Tachosil®). Penile curvature, penile length and erection score were measured before and after surgery. RESULTS: Twenty-one patients, aged 52,13 (18-70 years) were included. The average follow-up after surgery was 8,36 months (1-14 months). Early complications included two hematomas and one dysuria (Clavien 1). One patient had a penile prosthesis hernia 3 months after surgery, and needed a new surgery (Clavien 3B). Patients stayed at the hospital 1.38 night (1-5) and operating time was 158min (102-249min). Average penile curvature after surgery was 5.88° (0-30°), while it was 82.75° (50-100°) before. Erection score increased from 7.62 (3-10) to 7.86 (4-10). There was no modification of the penile length 11.92cm (11-14.5) after surgery and 12.09cm (10-15cm) before. CONCLUSION: The use of TachoSil® reduces the operative time, is easy to use and has hemostatic properties at a low cost. However, prospective randomized trial and long terms results are required to confirm our encouraging results. LEVEL OF EVIDENCE: 3.