High pressure balloon dilatation of the ureterovesical junction in primary obstructive megaureter: Infectious morbidity.

INTRODUCTION: The objective of this study is to investigate the infectious morbidity associated with high-pressure balloon dilatation (HPBD) and an indwelling double J stent, in primary obstructive megaureter. METHODS: We reviewed the cases of 12 patients undergoing endoscopic treatment for primary obstructive megaureter from January 2012 to January 2015. The characteristics of the infection and data concerning the patient and the intervention were analyzed. RESULTS: The frequency of preoperative urinary tract infection (UTI) was 58%. The procedure was feasible in 100% of cases. Two patients required a second dilatation. One patient underwent Cohen's ureteral reimplantation after failure of the second dilatation. The frequency of postoperative UTI was 25%. All these infections occurred in patients with a double J stent. None of the patients had UTI after stent removal. None of the patients developed postoperative vesicoureteral reflux (VUR) after HPBD. CONCLUSION: Endoscopic balloon dilatation has been shown to have good short- mid- and long-term outcomes. In our experience, the morbidity of this procedure mostly results from infections, exclusively related to the use of a double J stent. The placement of a double J stent has a significant medical and economic impact. A definitive decision about the utility of double J stents will require studies of further dilatation without the placement of a double J stent. LEVEL OF EVIDENCE: 4.

Long-term results with the laparoscopic transposition of renal lower pole crossing vessels.

BACKGROUND: For the treatment of ureterovascular pelviureteric junction obstruction (PUJO), transposition of lower pole crossing vessels (LPCV) has been described as an alternative to dismembered pyeloplasty. PURPOSE: To report on the long-term follow-up of children after laparoscopic transposition of LPCV. METHODS: A retrospective analysis of 70 children consecutively treated by laparoscopic transposition of LPCV. Candidate patients were selected on the basis of clinical history, renal ultrasound (US), and pre-operative mercaptoacetyltriglycine (MAG-3) scan. Selection criteria included: presence of LPCV with SFU Grade 1-2 hydronephrosis, impaired drainage on MAG-3 and intraoperative normal pelviureteric junction (PUJ) and ureter peristalsis. Thinned parenchyma, impaired renal function, or history of prenatal hydronephrosis were not considered as exclusion criteria. Children were clinically followed up with US and MAG-3 scan. Success was defined by symptom resolution with improvement in hydronephrosis. RESULTS: Seventy children, aged 8.3 years (range 2.75-16.0), were selected. Procedures were performed through transperitoneal laparoscopy (n = 42) or were robotic-assisted (n = 28). Operative time was 120 min and length of hospital stay was 2 days. The outcome was successful in 67/70 patients (96%), with a median follow-up of 52 months (range 13-114). There were three failures in children who eventually underwent dismembered pyeloplasty for a symptomatic, undiagnosed, intrinsic PUJ obstruction. Two of them had been postnatally followed for a resolving prenatally diagnosed hydronephrosis. Three children became free of symptoms, had improved hydronephrosis, but still showed impaired drainage on MAG-3 and are being closely followed up. DISCUSSION: Although this procedure proves to have long-term efficiency in selected indications, the main challenge is to intraoperatively ascertain the absence of associated intrinsic stenosis. Objective criteria remain difficult to establish, but intraoperative findings, including dependent, funnel-shaped, normal-looking PUJ with decreasing hydronephrosis after pelvis and LPCV mobilisation, and efficient peristalsis across the PUJ under intraoperative diuretic test, represent a low likelihood of associated intrinsic stenosis. Ipsilateral impaired renal function doesn't seem to be associated with an adverse outcome. In contrast, a prenatal history of mild or self-resolving hydronephrosis in a patient later presenting with intermittent dilatation, raises the suspicion of associated intrinsic PUJ obstruction, as it is associated with a higher risk of failure. CONCLUSION: With a long postoperative follow-up, the robotic-assisted or laparoscopic vascular hitch procedure has been successful in treating a selected group of children with obstructive LPCV, and represents a safe and reliable alternative to standard dismembered pyeloplasty in the absence of intrinsic PUJO suspected on prenatal US.

[Videoscopic resection of a thrombosed aneurysm of a patent ductus arteriosus in a neonate]. / Résection par vidéo-thoracoscopie d'un anévrisme thrombosé du canal artériel du nouveau-né.

Aneurysmal dilatation of a patent ductus arteriosus is a rare condition. One hundred and fifty three cases have been reported, of which 59 (39%) were operated, with an operative mortality of 16%. The authors report a case detected in a premature neonate on chest X-ray showing a mass in the mid-mediastinal region. Surgical resection was undertaken by video-thoracoscopy. Peroperative analysis of the resected specimen suggested a vascular structure and this was confirmed by histological study, which showed spontaneous aneurysm of a thrombosed patent ductus arteriosus or cystic residue of a patent ductus arteriousus. The authors underline the importance of peroperative puncture of structures of uncertain origin and the possibility of conversion of such a procedure to that of an extreme emergency.

[Comparison of the methods of surgical treatment of retinal detachment caused by dialysis retinae at the ora serrata]. / Porównanie metod operacyjnych odwarstwienia siatkówki spowodowanego oderwaniem od rabka zebatego.

In the period of 1972-1973 in the Poznan Department of Ophthalmology were performed 23 operations of scleral infolding with diathermocoagulation in cases of ora serrata dialysis (giant tears were not included in this group). Fifteen years later 20 persons were called for examination. Examined were: the visual acuity, evaluation of the lens and the condition of the retina was checked by a tree-mirror lens with a particular attention for the site of infolding and the appearance of the macula. The 2d group consisted of 20 cases of ora serrata dialysis who underwent surgical procedure of scleral invagination with the use of Lincoff sponge in the form of a parallel implant--connected with cryopexy (period 1984-1985). After such a long time both methods showed to be successful in the term of anatomical effect (90-95%) instead the functional result depended on macular changes, the period of detachment, the character of the trauma, the presence of demarcation lines and on pigmentary changes of the retina.

[Priapism: a severe paediatric complication of Fabry disease]. / Le priapisme: une complication pédiatrique grave de la maladie de Fabry.

Fabry disease is an X-linked recessive lysosomal storage disorder caused by α-galactosidase A deficiency. Although the disease presents in childhood, diagnosis is often delayed to adulthood or missed, presumably due to the lack of specificity of the symptoms and to the absence of major complication during the paediatric years. We report a 9-year-old boy known to have a Fabry disease who presented an episode of priapism. Successful treatment was achieved by repeated corporeal aspiration under general anaesthesia. This case is the fifth report of priapism in children with Fabry disease, suggesting that priapism may be a severe vascular complication of the disease during infancy. This report emphasizes the importance of an early diagnosis and treatment of Fabry disease, including enzyme replacement therapy, to prevent major disease-associated morbidity and to optimize patient outcomes.

Spongioplasty and separation of the corpora cavernosa for hypospadias repair.

OBJECTIVE: To describe a surgical method (a modified Duplay technique), and its results, for hypospadias repair, developed to avoid the common complication of fistula. PATIENTS AND METHODS: The urethroplasty was modified so that it no longer comprises a simple approximation of the urethral plate with no dissection. The inferior surface of the corpora cavernosa is exposed as far as the lateral border and to the end of the glans, allowing tension- free suturing of urethral tissues, with a lengthening effect of the intermediate plane. This corrects chordee and especially the 'bucket-handle' glans, and protects the reconstructed urethra and proximal urethra. The study included 51 children who had their hypospadias repaired over a 9-month period (mean age at surgery 20.6 months, range 1-11 years); 14 had coronal, three anterior penile juxta-coronal, 23 anterior penile, four medium penile, five posterior and two penoscrotal hypospadias. RESULTS: All children were followed and no fistula was apparent in any with anterior hypospadias; two fistulae occurred after repair of the posterior form. The risk of fistula is therefore reduced (two in 51). CONCLUSION: This technical modification can be used to treat all forms of distal hypospadias (glanular, glanulo-preputial, and anterior penile). It was also used for several cases of more severe hypospadias. These good results must be confirmed in a larger series of patients.