[Place of the ureteroscopy in the treatment of the children urolithiasis]. / Place de l'urétéroscopie dans le traitement de la lithiase chez l'enfant.

OBJECTIVE: To determine the efficiency and the role of ureteroscopy in the treatment of urolithiasis in children. METHODS: A multicenter retrospective study was conducted between January 2006 and March 2008 in the department of pediatric surgery and urology of Besançon, Lyon and Grenoble. The clinical data of 17 children having benefited from one or more ureteroscopy procedures for urolithiasis were analyzed. These data concerned age, sex, antecedents of metabolic diseases, existence of a malformed uropathy, how the urolithiasis was discovered, therapeutic indications, endoscopic procedures, type of endoscopic treatment for urolithiasis, results and complications. RESULTS: Twenty-six ureteroscopies were carried out for 17 children (eight girls and nine boys) aged between 9 months and 12 years (mean: 5 (1/2) years old) as a first-line treatment or after extracorporeal shock wave lithotripsy. A 6/7,5 Fr semi-rigid ureteroscope was used in all case. Only once, the operator chose a flexible ureteroscope. Lithotripsy was carried out 15 times with YAG Holmium laser, four times with Swiss Lithoclast and six times by simple extraction with a Dormia type basket .A stent probe was left in place after endoscopy for 14 children. The "stone free" rate was 88% with an average hindsight of 11 months. Two incidents without major complication were recorded: a section of the guide by the laser beam and a perforation with extravasation of the contrast agent. CONCLUSION: Ureteroscopy is the first-line treatment in isolated ureteral urolithiasis. On the other hand, LEC remains the treatment of choice for Starghon calculi, since LIC should be offered only in the event of failure of LEC.

[Multicystic dysplastic kidney disease: update and information for parents at the time of prenatal diagnosis]. / Dysplasie rénale multikystique: mise au point et information pour les parents lors du diagnostic anténatal.

Multicystic kidney disease (MCKD) is the most common form of Congenital Abnormality of Kidney and Urinary Tract (CAKUT). This anomaly of renal development is characterized by unilateral enlarged cystic formations and fibrous dysplastic parenchyma. The long-term prognosis is usually good; however because of reduced nephron mass, an early prevention of cardiovascular risk and nephrotoxicity is recommended. A lifelong follow-up of blood pressure, serum creatinine and microalbuminuria seems logical as well as in other patients with a single kidney. MCKD is usually diagnosed during pregnancy so that parents often question about long-term prognosis and follow-up. Therefore, we propose an information sheet for parents.

220 cases of distal hypospadias: results of MAGPI and Duplay procedures. Respective place of glanduloplasty and urethroplasty.

220 distal hypospadias have been operated over a period of 10 years: 53 glandular, 144 coronal and 23 anterior penile subcoronal hypospadias with no chordee. Although with 131 MAGPI procedures we had only 3 urethral complications (one fistula, one total and one partial disunion), it does not seem to be a well adapted procedure for the correction of coronal and anterior penile hypospadias: the new meatus is not exactly apical, the glans remains short on its inferior side, and we often noticed a distal curvature at the end of the intervention. The urethroplasty technique that we performed 89 times avoids these disadvantages: the urethra is reconstructed in 2 layers as far as the summit of the glans according to Duplay's procedure, the urethrocutaneous adhesions are freed down the penis, the distal thin urethra is covered by an intermediate layer and the shortage of ventral skin is compensated for by the formation of a circular esthetic mucous annulus. There have been no complications with glandular hypospadias (7 cases), 4 with coronal hypospadias (64 cases) and 4 with anterior penile hypospadias (18 cases). While the MAGPI procedure remains an excellent technique for the correction of glandular hypospadias, the Duplay's procedure is better adapted for the correction of coronal hypospadias, in spite of the occurrence of more frequent (easily treated) fistula (6.25%). The juxta coronal position of some anterior penile hypospadias is still better repaired by the Mathieu's or the Snyder's procedures.

Single-stage correction of posterior hypospadias (178 cases). Comparison of three techniques: free skin graft, free bladder mucosal graft, transverse pedicle preputial graft.

Three techniques have been developed for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. This multicenter retrospective study of 178 children who underwent surgery for posterior hypospadias was designed to compare the results achieved with these procedures. Free skin grafts (15 cases) resulted in the most frequent complications, and in particular the most severe strictures; in our opinion this technique should be abandoned. Pedicle preputial grafts (133 cases) gave the greatest number of successes from the outset, and should be preferred whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts (30 cases) were not as good as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position, and for children who have already undergone multiple operations.

Evaluation of a hydrocolloid dressing.

A hydrocolloid dressing was compared to adhesive skin tapes on children's postoperative wounds. A total of 170 children of varying ages were randomised in two parallel groups, in nine centres of plastic, thoracic, gastrointestinal, urogenital and orthopaedic surgery. Skin closure was satisfactory in both groups, with 76 (89.4%) healthy closures without dehiscence in the hydrocolloid group and 81(95.3%) in the control group; a relationship was found between partial closures/dehiscence and the type of surgical procedure. No product-related maceration, infection or adverse event was reported during the study and both groups showed very satisfactory cosmetic results.

Evaluation of a hydrocolloid dressing.

A hydrocolloid dressing was compared to adhesive skin tapes on children's postoperative wounds. A total of 170 children of varying ages were randomised in two parallel groups, in nine centres of plastic, thoracic, gastrointestinal, urogenital and orthopaedic surgery. Skin closure was satisfactory in both groups, with 76 (89.4%) healthy closures without dehiscence in the hydrocolloid group and 81 (95.3%) in the control group; a relationship was found between partial closures/dehiscence and the type of surgical procedure. No product-related maceration, infection or adverse event was reported during the study and both groups showed very satisfactory cosmetic results.

[Endoscopic treatment of vesicorenal reflux in children. Review of three years experience and prospects for the future]. / Traitement endoscopique du reflux vésico-rénal chez l'enfant. Le point sur trois années d'expérience et perspectives d'avenir.

Endoscopic injection of teflon paste, used since 1984, represents an alternative to the surgical treatment of vesico-renal reflux. The success rate varies from 75 to 89% after a single injection and from 85 to 95% after two injections, according to the teams. The results are less satisfactory for the high grades and for refluxes on duplicity (25 to 45% failure rate). This technique is particularly attractive in the case of a difficult surgical intervention, notably when a reimplantation has failed, in the case of reflux on neurological bladder, urethral valves or exstrophy. Various causes of failure or relapse are considered. The advantages of the technique are obvious (low morbidity, very short hospital stay) and surgery is always possible in the case of failure. After one or two years, the reflux reappears in 2 to 9% cases. Long term results cannot be assessed as the follow-up period is too brief at the present time. For this reason, and although the endoscopic and surgical findings are reassuring, tolerance to teflon both locally and at a distance requires confirmation and other products such as collagen are now being used.

[Endoscopic treatment of vesicorenal reflux in children]. / Traitement endoscopique du reflux vésicorénal chez l'enfant.

Based upon a 7 years personal experience and the results published in the literature, the author analyses the current knowledge on the endoscopic treatment of vesicoureteric reflux (VUR) in children. Teflon has been the most widely used product, with more than 6,000 subureteric injections during the last 9 years over the world, and a rate of successful endoscopic correction of VUR of approximately 85%. Despite the criticisms addressed to teflon concerning its carcinogenic potential and the risk of vascular migration, neither clinical manifestations related to lung, liver or brain migrations, nor carcinogenic degeneration have been so far observed. Ureteral stenoses has been the only rare complication (< 1%), leading to secondary surgical treatment of VUR with good outcome. Persistent or recurring VUR can always be surgically treated without particular difficulties. An alternative to teflon has been looked for in recent years. The results obtained with bovine dermal collagen are presently rather disappointing due to a high rate of failure. On the contrary the preliminary results obtained with injection of microparticulate silicone appear very promising: correction of VUR in over 90% of cases and good local tolerance adding to absence of carcinogenic and migration risks. Further trials and a longer evaluation period are necessary before to consider microparticulate silicone as the ideal product to be used in the endoscopic treatment of VUR.

[Acute scrotum in the child]. / Les bourses aiguës de l'enfant.

Torsion of the spermatic cord is the most common etiology of acute scrotum in children. Children with torsion usually present with acute scrotal pain, nausea and vomiting, and only early surgical treatment, within 6 hours of the onset of symptoms, may ensure the preservation of the testis. For that reason any acute scrotal pain with edema requires urgent specialized evaluation. Other etiologies include less severe diseases as torsion of an appendage, epididimytis, trauma, and other rare conditions such as acute idiopathic scrotal edema.

[Meconium periorchitis. Two case reports]. / Epanchement méconial péritesticulaire. A propos de deux cas.

CASE REPORTS: Two cases of meconium periorchitis respectively in a ten-day- and a five-month-old infant are reported. The presenting symptom was a scrotal mass, isolated in one case and associated with pain and inflammation in the other case. Intraoperative histological diagnosis allowed conservative surgery in one case. COMMENTS: About 40 cases of scrotal manifestations of an intrauterine perforation of the gastrointestinal tract are reported in the literature. In cases with associated intraperitoneal calcifications, the diagnosis is easy and surgical exploration may be avoided, spontaneous resolution being the rule. However, in half of the cases, a scrotal mass is the only manifestation and raises the question of a testicular tumor. CONCLUSION: Unfamiliarity with this unusual entity may lead to unnecessary orchiectomy.

[Familial association of penoscrotal transposition and diphallia (double penis) with patella aplasia]. / Association familiale d'une transposition pénoscrotale et diphallia (pénis double) à une aplasie rotulienne.

BACKGROUND: Diphallia and penoscrotal transposition are rare, generally sporadic, abnormalities. CASE REPORTS: Case 1: A 2-1/2-month-old boy was admitted in hospital because he suffered from complete penoscrotal transposition, with moderate hypospadias for which he was operated on. Examination at the age of 6 years showed hypoplastic and dislocated patellae. Case 2: A 2-month-old boy, brother of case 1, also suffered from incomplete penoscrotal transposition, associated with diphallia but without double bladder, that was operated on. Ultrasonography at the age of 17 months showed absence of patellae. The sister of these two patients was normal but her mother displayed ambiguous genitalia with phallic structure located beneath partially fused labial folds. Her patellae were also absent. CONCLUSION: This is the first familial case of true diphallia associated to penoscrotal transposition. This abnormality is also associated to absence of patellae and seems to be dominantly inherited.

[Malformations of male internal genitalia originating from the Wolffian duct]. / Malformations des organes génitaux internes masculins issus du canal de Wolff.

This review includes the description and treatment of the various malformations of the male internal genitalia of Wolffian origin. Congenital epididymal cyst is the most frequent anomaly; it is usually asymptomatic so that surgery is seldom necessary. Agenesis of the deferent is usually discovered during surgery for undescended testis and is frequently associated with a homolateral renal agenesis. Ectopia and duplication are other possible anomalies affecting the deferent. Seminal vesicle cysts is mainly discovered after puberty; pelvic pain and/or urinary symptoms are the main revealing signs. It is frequently associated with other uro-genital anomalies, mainly renal agenesis.

[Severe urinary tract and cutaneous lesions after umbilical cord artery puncture and direct injection of hypertonic sodium bicarbonate to the newborn in the delivery room. Report of three cases (author's transl)]. / Lésions urinaires et cutanées par ponction d'une artère du cordon ombilical et injection à la serinque de soluté bicarbonaté hypertonique chez le nouveau-né en salle d'accouchement. A propos de trois observations.

Three cases of necrotizing and calcifying lesions of low urinary tract, buttock and adjacent perineum are reported. These lesions have been induced by direct syringe injection into an umbilical artery of 42% sodium bicarbonate solution at the dose of 5 to 6 ml/kg of body weight. Radiographic examinations are very important to study the urinary tract lesions. These have been surgically controlled in two cases. The follow up ranges from 10 to 21 1/2 months. On the bladder initial necrotizing lesions are followed by calcification and parietal retraction. These bladder lesions induce a more or less important ureterohydronephrosis. To these constant lesions are variably associated urethral calcifications and stenosis, distal ureter calcifications. These lesions seem to be related to the sodium bicarbonate hyperosmolality, to the injection conditions, and to the local hemodynamic features.

[Cystic dysplasia of the rete testis and ipsilateral kidney agenesis in children]. / Dysplasie kystique du rete testis et agénésie rénale ipsilatérale chez l'enfant.

BACKGROUND: Cystic dysplasia of rete testis, a rare abnormality, is often associated with renal agenesis. CASE REPORT: A 5-year-old boy was examined because he presented large scrotum. This was initially considered as hydrocele. Surgery showed a cystic dysplasia of the testis that in this patient was associated with ipsilateral renal agenesis. CONCLUSION: This congenital abnormality, explained on the basis of embryological development, has been reported in 15 children. The testis appears cystic at surgical exploration; echography can affirm diagnosis and MRI can give specific features. A conservative attitude is proposed as this lesion is benign. Long-term follow-up is recommended for possible painful effects or growth of the lesion.

[Management and treatment of uropathies detected in utero. Evaluation of 8 years' experience]. / Prise en charge et traitement des uropathies dépistées in utero. Bilan de 8 années d'expérience.

Over an 8 year period, the antenatal diagnosis of uropathy was made in 125 fetuses, but confirmed in only 22%; in the other cases, it was inadequate (50%) or wrong (28%). It was only in a few cases that surgery was any use in the first days of life (sectioning urethral valves, and temporary nephrostomy); in most cases, surgery was carried out between 1 and 3 months of age: total or partial nephrectomy (mainly for multicystic dysplasia and ureteral duplication with a ureterocele or ectopia), and usually conservative surgery (resection of the pyelo-ureteral junction, uretero-vesical implantation because of reflux or mega-ureter). The long-term results depend upon the degree of renal dysplasia: the prognosis was good in all cases of hydronephrosis that were operated on, but it is often poor when uropathies are characterized by early obstructive phenomena in intra-uterine life as occurs with urethral valves. In those cases, renal insufficiency cannot always be prevented by neonatal surgery.

[Gastroesophageal reflux with combined caudal and halothane anesthesia in children]. / Reflux gastrooesophagien sous anesthésie caudale et halothane au masque chez l'enfant.

Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of the use of Tissucol in pediatric urology]. / Intérêt de l'utilisation du Tissucol en urologie pédiatrique.

The authors have tried to evaluate the value of fibrin adhesive in 85 cases of urogenital surgery in children. The local hemostatic effect seems to be very useful in urethroplasty for hypospadias. Its application in vesical, ureteral or urethral sutures probably prevents fistulas.

[Treatment of anterior hypospadias: comparison of modified Mathieu and Duplay techniques (report of 840 children)]. / Traitement de l'hypospadias antérieur: comparaison de la technique modifiée de Mathieu au Duplay (à propos de 849 enfants).

PURPOSE: The objective of this study is the comparison of 2 surgical procedures in the treatment of primary anterior hypospadias including the evaluation of short-term and long-term results. PATIENTS AND METHODS: A retrospective study of the results of the modified Mathieu procedure performed in 392 patients presenting with previously untreated anterior hypospadias at one center by the same experienced surgeon is compared with the results of the modified Duplay procedure performed in 457 patients in a second center by a second experienced surgeon, both series spanning a period of 10 years. RESULTS: Follow-up ranged from 21 months to 10 years. Overall, 7 of 392 patients (1.7%) treated by the Mathieu procedure had complications requiring surgery compared to 32 of 457 patients (7%) treated by the Duplay procedure, a difference that is statistically significant (P < 0.05). Patient satisfaction was excellent in both groups and cosmetic results were considered satisfactory by the parents in all 843 patients. CONCLUSION: Both the modified Duplay and the Mathieu techniques are reliable procedures with reproducible results, a minimal risk of fistula formation as well as excellent cosmetic and functional results.

[Modified Duplay technique in the treatment of hypospadias. Report of 585 cases]. / Technique de Duplay modifiée dans le traitement de l'hypospadias. A propos de 585 cas.

The surgical repair of anterior hypospadias depends on the surgeon's custom and the anatomical variations of this anomaly. However, most publications agree nowadays on the one-stage surgery. We report on 585 hypospadias operated in our department. Our procedure is based on the Duplay technique, in addition to personal modifications in order to correct the frequently associated penis anomalies. The procedure is described herein. Aesthetic and functional results are reported and seem to be very satisfactory in comparison with the literature and permit the homologation of our technique.

[Two rare case reports of ureteral triplication]. / A propos de deux cas rares de triplication urétérale.

Triplication of the upper urinary tract is rare. It is classified according to its extent and four types have been documented. Since the first description of ureteral triplication by Wrany only about a hundred cases have been reported in the literature. Paediatric cases are very few and female patients seem more concerned. The embryological event resulting in ureteral triplication derives from multiple ureteral buds arising from the Wolffian duct with fissuring of one or more of them. We report on two cases of ureteral triplication. The first one associated with an extravesical ectopic ureter and a dysplasic kidney. Diagnosis was particularly difficult and treatment consisted of total nephrectomy. The second case was associated with an upper pole hydronephrosis and a partial nephrectomy was realized.