[Endoscopic treatment of intermittent vesico-ureteral reflux in women. Apropos of 40 cases]. / Traitement endoscopique du reflux vésico-urétéral intermittent chez la femme. A propos de quarante cas.

UNLABELLED: To evaluate the clinical efficacy of endoscopic treatment of intermittent vesicoureteric reflux in adult females. METHODS: Forty women presenting with recurrent urinary tract infection related to intermittent vesicoureteric reflux, underwent subureteric Teflon injection according to the O'Donnell procedure (mean volume of Teflon 1 cc). Thirty patients required one injection, while nine patients needed two injections. Meatostomy or urethral dilatation were associated in 29 cases (72.5%). RESULTS: No complication occurred. Clinical results were evaluated using a questionnaire. The mean follow-up was 33.5 months (range 12-72), complete disappearance of infection was obtained in 31 out of 40 cases (77.5%). Recurrent urinary infection occurred in 9 cases. After complementary Teflon injection, urinary infection disappeared in 5 patients and finally a complete cure was obtained in 36 out of 40 cases (90%). CONCLUSION: Intermittent vesicoureteric reflux could be easily cured by an endoscopic procedure. This minimally invasive technique is simple and well adapted to this relatively benign disease.

[Long term results of endoscopic treatment of reflux in hemodialysis patients waiting for transplantation]. / Résultats à long terme du traitement endoscopique du reflux chez les hémodialysés en attente de transplantation.

Between January 1986 and April 1988, 13 patients (mean age: 35 years) waiting for renal transplantation (mean duration of haemodialysis: 46 months) were treated by means of O'Donnell's technique. Vesico-ureteric reflux was unilateral in 6 patients and bilateral in 7 patients (20 refluxing ureteric units). Reflux was classified as Grade II for 7 ureters, Grade III for 8 ureters and Grade IV for 5 ureters. The volume of Teflon injected ranged from 1 to 4 cm3 and 6 patients received repeated injections. No complications were observed. Complete resolution of reflux was obtained in 9 patients (69%), i.e. 15 ureteric units (75%). Reflux persisted in 4 patients (31%), i.e. 5 ureteric units (25%). Three nephro-ureterectomies were performed in 2 patients with persistent high grade reflux, but 2 patients with Grade I reflux after endoscopic treatment were not operated. All patients were transplanted after endoscopic treatment (mean interval between correction of reflux and transplantation: 13 months) and a follow-up cystography was systematically performed after transplantation (mean follow-up after transplantation: 27 months): no recurrence of the reflux was detected (mean follow-up after endoscopic treatment: 40 months). Endoscopic treatment of reflux avoids the need for nephro-ureterectomy in 80% of haemodialysis patients waiting for renal transplantation and presenting with vesico-ureteric reflux.

[Kidney transplantation with cutaneous continent urinary diversion (apropos of 6 cases)]. / Transplantation rénale avec dérivation urinaire cutanée continente (à propos de 6 observations).

In a series of 525 renal transplantations performed between January 1987 and September 1990, 5 patients (i.e. 1%) presented with vesical, sphincteric and urethral lesions which prevented classical uretero-vesical or uretero-ureteric reimplantation and functionally satisfactory vesico-sphincteric reconstruction. Under these conditions, in which drainage of the urine into the bladder was impossible, a diversion was created using a continent intestinal reservoir constructed prior to the graft. Four Kock pouches and one Mainz pouch were created during the months preceding renal transplantation with a cadavre kidney. A sixth patient, transplanted in 1981, had to undergo continent urinary diversion in February 1988 after a non-functional bladder augmentation for problems of bladder drainage. We did not observe any mortality or major medical or surgical complications. The follow-up after transplantation in the first 5 patients is now 3, 6, 10, 37 and 40 months. Renal function is normal in all 5 cases with serum creatinine below 130 mmol/l. For the sixth patient, the follow-up is 9 years after the transplantation and 32 months after the continent urinary diversion; serum creatinine is 200 mmol/l and stable since the urinary diversion. Continence is excellent and the comfort of all of the patients is undeniable. However, all patients present with bacteriuria with no symptomatic urinary tract infection.

Treatment of primary vesicoureteric reflux by polytetrafluoroethylene injection: a middle-term follow-up study.

We have selected 38 patients (55 ureters) with primary vesicoureteric reflux successfully treated by endoscopic subureteric injection of Teflon. The success rate after 1 injection was 83.6%. Nine ureters required a 2nd or even a 3rd injection of Teflon to achieve success. The follow-up time for these successfully treated patients was 2-5 years, and results remained stable in 94.5% of cases. Endoscopic injection of Teflon seems to be a reliable alternative to open surgery in the treatment of primary vesicoureteric reflux.

Effect of the surgical technique on long-term outcome of pancreas transplantation.

To date there is no general consensus as to the best surgical technique for pancreas transplantation. Patients with a pancreas transplant functioning for 3 years or more were retrospectively investigated to compare three surgical techniques: segmental graft with duct obstruction (DO), whole graft with bladder drainage (BD), and whole graft with enteric drainage (ED). Several parameters were studied: patient and graft survival, rejection, long-term surgical and medical complications, and endocrine function. The best results in terms of graft survival and quality of metabolic control were obtained in the group that underwent whole graft transplantation with ED. At 3 years, overall pancreas graft survival was 65% for ED, 60% for BD, and 47% for DO. This surgical method has become the preferred technique in our unit.

Vesicoureteral reflux after kidney transplantation in children.

BACKGROUND: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation in adults varies between authors and there have been few reports in children. METHODS: We conducted a retrospective study in a single-centre paediatric cohort. Fifty-five of the 84 children who underwent kidney transplantation over a 5-year period were checked with routine cystography after a median of 8 months post-transplantation. Graft function and urinary-tract infections were assessed during the first 6 years after transplantation. RESULTS: VUR into the graft was present in 58% of the patients. Graft function and incidence of urinary-tract infections were similar in the two groups, independent of VUR. After having excluded infections attributed to the presence of a catheter, actuarial survival rates without pyelonephritis and without pyelonephritis following a first lower urinary-tract infection were worse in patients with VUR (P:=0.017 and P:=0.0039 respectively). None of the eight patients with VUR treated with antibiotic prophylaxis after a first acute pyelonephritis (APN) episode presented subsequent APN after 4.4+/-3.3 years on therapy. CONCLUSIONS: VUR to the graft occurred in more than half paediatric renal transplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with VUR.