[Uretero-vesical implantation after failure of endoscopic treatment of reflux: anatomical and histological study of 61 resection specimens from 40 children]. / Réimplantation urétéro-vésicale après échec du traitement endoscopique d'un reflux: étude anatomique et histologique de 61 pièces de résection chez 40 enfants.

OBJECTIVE: To evaluate the anatomy and histology of the ureterovesical junction resected during secondary surgical reimplantation for persistent reflux after failure of initial endoscopic treatment by polytetrafluoroethylene (Teflon) in 27 cases and polydimethylsiloxane (Macroplastique) in 13 cases. MATERIAL AND METHOD: 61 ureterovesical junctions from 40 children were studied histologically. The mean age of the patients at the time of the operation was 4.1 years (range: 1 to 15 years). The mean interval between endoscopic injection and surgical reimplantation was 15.3 months (range: 2 to 54 months). RESULTS: Persistent reflux was not correlated with the anatomical situation of the implant, which was found to be in a satisfactory position in 52.4% of cases. Both of the substances used induced a giant-cell macrophage reaction which colonized the implant and triggered new vessel formation. Macroplastique appeared to be associated with a more intense inflammatory reaction than Teflon. Despite the difference in particle size, the two substances induced a macrophage phenomenon characterized by microfragmentation into 6 micron particles. No conclusions can be drawn concerning distant migration, but this study showed rarefaction of particles which were replaced by fibrosis, the density of which was correlated with the age of the implant. CONCLUSION: Extinction of the local reaction induced by the products used in this study appears to be long and the end of this process is unknown, which justifies prolonged surveillance of children treated for reflux by endoscopic submeatal injection.

[Intestinal volvulus after enterocystoplasty: report of three cases in children]. / Volvulus intestinal après entérocystoplastie: à propos de trois cas chez l'enfant.

Enterocystoplasty complications related to the presence of intestinal mucous presence in the bladder are well known and well reported in the literature. Mechanical problems in the intestinal tract due to using gut for bladder augmentation are not as well recognised. We analyzed three cases of children treated by ileocystoplasty who presented an intestinal volvulus in two cases and a cecal volvulus in one case around the vascular pedicle of the intestinal patch used for bladder augmentation.

Enterocystoplasty complications in children. A study of 30 cases.

BACKGROUND/PURPOSE: Bladder augmentation for small vesical capacity represents an important aid to these patients, but the appearance of complications is not rare. We analysed the complications of the enterocystoplasty techniques used in our Department. METHODS: From 1983 to 1997 sixteen girls and fourteen boys were treated. We performed 28 bladder augmentations (in 13 cases using small bowel, in one case using ileum and caecum and in 14 cases using sigmoid colon) and 2 bladder substitutions (in one case with ileum and sigmoid colon and in the second using a colonic segment). RESULTS: Twelve children present recurrent urinary infections. In five children bladder stones were formed (among them a case of familial cystinuria-lysinuria). Two children presented intestinal volvulus and another one a caecal volvulus. In two children a perforation of the augmented bladder was treated operatively. An 11-years-old child presented severe electrolyte disturbances. CONCLUSIONS: The complications presented in our patients confirm the view that they are associated with intestinal mucosa in the bladder and our study proves, once more, the current necessity to seek alternative tissues for bladder augmentation.

[Urothelium cell culture: what is the future? An experimental study in rabbits]. / La culture cellulaire d'urothélium: quel avenir? Une étude expérimentale sur le lapin.

Since the first human bladder reconstruction in 1989 using an ileal segment, many alternatives have been proposed to recreate a bladder reservoir as adapted as possible to physiological conditions. Since the development of urothelial cell culture alone and then in combination with matricial supports, various experimental trials have studied the possibility of using this neurothelium for surgical purposes. This experimental study in rabbits tested the compatibility of two different biosynthetic supports in an enterocystoplasty and the survival in in vitro urothelial cells grafted onto this support.

[Intravesical morphine analgesia in pediatric urology]. / Analgésie par morphine intravésicale en Urologie Pédiatrique.

OBJECTIVE: Evaluation of the technique and value of intravesical morphine instillation after ureterovesical reimplantation in children. MATERIAL AND METHODS: From July 1997 to June 1998, the Duckett protocol (Philadelphia, USA), comprising slow intravesical infusion of morphine for the first three prosoperative days, was applied in 25 children aged five months to twelve years after ureterovesical reimplantation surgery, without bladder catheterization. Postoperative pain was evaluated by CHEOPS and VAS scales and by all nursing staff by an anonymous questionnaire. RESULTS: Analgesic assessment tests confirmed a significant improvement of postoperative comfort, despite the absence of a bladder catheter. No adverse effects or complications related to intravesical morphine instillation were observed. CONCLUSION: Intravesical morphine instillation is an easy, effective postoperative analgesia technique, allowing good tolerance of the absence of postoperative bladder catheterization.

[Benign ureteral polyps in children: apropos of a case]. / Polype urétéral bénin chez l'enfant: à propos d'un cas.

Ureteric polyp is a benign lesion, and an uncommon cause of hydronephrosis in children. It is associated with intermittent lumbar pain and haematuria. The diagnosis is usually based on intravenous urography or retrograde urography. Treatment must be conservative and consists of simple resection of the polyp, associated with varying degrees of ureteric resection depending on the size of the lesion. No case of recurrence after treatment has been reported to date. The authors report a case in a 7-year-old boy and present a review of the literature.

Idiopathic varicocele in children and adolescents--which therapeutic choice?

61 children were studied and treated between January 1986 and September 1993 for idiopathic varicocele. The aim of our study was to evaluate the advantages and disadvantages of the different techniques and to show the progression to a greater efficacy. The mean age at the time of therapy was 14 years, ranging from 7 to 16 years. All children presenting with pain or testicular asymmetry were treated. Four asymptomatic children were followed for 2 years before treatment. 36 children were treated by surgical ligature via the inguinal approach; 8 with a resection of the varicose veins as far as the tunica vaginalis. 14 children were treated by percutaneous sclerotherapy including 1 patient following unsuccessful classical surgical treatment. 12 children were treated by surgical inguinal ligature associated with peroperative phlebography and thrombosis. 56 children were reviewed postoperatively over a period which varied from 2 months to 4 years (5 lost to follow-up). For the 36 classical ligatures: 25 good results, but 9 hydroceles (5 out 8 varicose resections): 70% good results. 7 failures and 4 lost to follow-up. For the 14 percutaneous sclerotherapy: 4 technical failures (impossibility to catheterize the spermatic vein): 10 good results. For the 12 ligatures with peroperative phlebography and thrombosis: 11 good results and 1 lost to follow-up. All the above procedures were carried out at our out-patient clinic. The therapeutic choice will therefore have to take into consideration a procedure which produces the lowest morbidity rate and proves to be the most effective. The association of surgical ligature, phlebography and thrombosis meets these requirements.