Le pseudo kyste abdominal: une complication de la dérivation ventricule péritonéale à propos d'un cas / The abdominal pseudocyst: a complication of ventriculoperitoneal bypass about a case

Le pseudokyste abdominal est une complication rare pouvant survenir chez les sujets porteurs d'une dérivation ventriculo-péritonéale (DVP). Nous rapportons le cas d'un adolescent de 11 ans, chez qui une DVP a été réalisée pour une hydrocéphalie congénitale. Il présentait une distension abdominale progressive sans notion de troubles de transit. L'imagerie (échographie, urosacnner) a permis de mettre en évidence un épanchement péritonéal de grande abondance organisé, à paroi fine et régulière, exerçant un effet de masse sur la vessie et les uretères, responsable d'une urétérohydronéphrose bilatérale. Le bout distal du cathéter de DVP a été visualisé dans la collection

The abdominal pseudocyst is a rare complication that can occur in subjects with a ventriculoperitoneal drain (VPD). We report the case of an 11-year-old adolescent with congenital hydrocephalus antecedent, for whom a ventriculoperitoneal shunt was made. He presented a progressive abdominal distension without notion of transit disorders. Abdominal ultrasound and uroscanner revealed an organized peritoneal effusion of great abundance, thin and regular wall, exerting a mass effect on the bladder and the ureters responsible for bilateral uretero-hydronephrosis. Above all, it has made it possible to individualize the distal ventriculo-peritoneal bypass catheter projecting in the effusion

Ureteroscopy Outcome and Its Determinants in a Resource-Limited Setting

Ureteroscopy is a major diagnostic and therapeutic technique for lesions of the ureter and intrarenal collecting system. METHODS: A retrospective chart review was done at St. Paul's Hospital Millennium Medical College, Ethiopia to determine the outcome of ureteroscopy and factors affecting it. The study period was from January 2018 to April 2018. Multivariate analysis was done to determine factors affecting stone clearance and success rate. RESULT: One hundred six patients who underwent semirigid ureteroscopy were included in the study. The male-to-female ratio was 1.8:1. The mean age of the patients was 36.4 years (±12.6). Ninety-six (90.6%) patients were found to have ureteric stones, while 9(8.5%) patients had a ureteric stricture. Ureteroscopy therapeutic interventions for stones were successful in 89 (92.7%) patients. The mean procedure time and postoperative hospital stay were 44 minutes (±23.7) and 2.5 days (±2.5) respectively. Intraoperative complications (ureteric avulsion, hemorrhage, and ureteral perforations) occurred in 6(5.7%) patients. The stone clearance rate was 54.7% (52). The site of obstruction was passed in 93 patients making the success rate of the procedure 87.7%. The absence of intraoperative complications was significantly associated with success rate. Patients with intraoperative complications have low success rate (20%) compared to patients without complications (92.3%), p=0.42. CONCLUSION: Semirigid ureteroscopy had a good success rate, especially for stones in the distal ureter and if there is no flexible ureteroscope, it is an acceptable alternative

Endoscopic management of ureteric stones: our initial experience

The aim of this study is to present our initial experience with intracorporeal pneumatic ureterolithotripsy highlighting the pattern of patients' clinical presentation, techniques, and limitation of the procedure.Materials and Methods:This is a retrospective study of cases of ureteric stones managed over a period of 18 months in a private hospital. Data obtained include patients' sociodemography, clinical presentation, stone burden, procedural technique, complication, and need for a secondary procedure. Data were analyzed using the Statistical Package for the Social Sciences version 21.Results:The total number of patients managed was 20 with an age range of 28­75 years and a mean of 48.2 ± 12.4 years. Majority of them, i.e., 11 (55%) were middle aged. Female gender was more predominant, 11 (55%). Flank pain was the most common mode of presentation. Right-sided stone occurred in 9 (45%), left sided in 7 (35%), and bilateral in 4 (20%). Stone location was in the upper ureter in 4 (16.7%), mid-ureter in 7 (29.2%), and lower ureter in 13 (54.2%). The stone size ranged from 6 to 18 mm with a mean of 9.7 ± 2.5 mm. Four patients (20%) required initial bilateral ureteric stenting before definitive procedure to allow for recovery from sepsis and/or nephropathy. All patients had double-J stenting and were discharged 2 days after the procedure. The procedure was successful in 19 (95%) with 100% stone clearance rate and complete resolution of symptom without any complication. One patient (5%) had a very hard upper ureteric stone which retropulsed into the renal pelvis requiring open nephrolithotomy.Conclusion:Endoscopic treatment of ureteric stone with intracorporeal pneumatic lithotripsy is a safe and effective treatment modality. It is, however, limited in the management of hard upper ureteric stone, especially those that are close to the pelviureteric junction due to the risk of retropulsion of the stone into the kidney

Predicting the Fragility of Renal Calculi in Response to Shock Wave Lithotripsy through their Radiographic Appearance

Objectives To evaluate the radiological characteristics of renal stones on plain X-ray film of the kidneys; ureters and bladder (KUB) area as predictors of stone fragility during shock wave lithotripsy (SWL). Patients and Methods This prospective study included 336 patients who had a single renal pelvic stone =20 mm and were managed by SWL at 3 different centers. The patients were classified according to the radiological appearance of the stone on KUB film in terms of homogeneity; smoothness of the outline; and radiodensity in comparison to the last rib. The primary endpoint was the stone-free rate (SFR) within 3 months post-SWL. Multivariate regression analysis was used to compare the results. Results The overall SFR was 71.43. SFR was significantly higher in heterogeneous compared with homogenous stones (86vs. 53; p0.01) and in rough compared with smooth surface calculi (77vs. 61; p0.01). SFRs for stones with density less than; similar to or higher than that of the last rib were 82; 69and 56; respectively (p0.01). Multivariate analysis showed a positive proportional relationship between stone fragility (SWL outcome) and one or more favorable radiological criteria. Conclusion The radiological characteristics of renal calculi could predict their fragility after SWL. Stones which were heterogeneous; rough; or less dense than the last rib on KUB film were more likely to disintegrate during SWL

Injuries encountered during rigid ureteroscopy in training centers

Objective To analyze the peroperative injuries encountered during ureterorenoscopy (URS) in two training centers in Egypt over a four-month period. Patients and Methods A prospective computerized database of 88 patients (38 males and 50 females) who underwent URS at two urologic university training centers (Al-Azhar University Hospital; Cairo and Assiut University Hospital; Assiut; Egypt) between July and October 2003 was analyzed. The procedures were elective in all cases. The indication for URS; the state of the ureter; associated pathologies; intraoperative injuries encountered and their management were recorded for analysis. Results All but seven patients were operated for therapeutic indications; mainly stone disease and ureteric strictures. Peroperative injuries were encountered in 14 patients (15.9) with the commonest type being mucosal laceration (57) followed by minor ureteric perforations. Major injuries in the form of ureteric avulsion; laceration and extravasation were noted in 2of the cases. The procedure was associated with inadvertent bladder or urethral injury in three patients. In all cases the diagnosis of the ureteric injury was prompt and confirmed by intraoperative ureterography. Treatment was started immediately. Conclusion URS; although an important tool in the management of upper tract pathology; is an invasive procedure; especially for therapeutic indications. It may result in significant complications that may jeopardize the integrity of the concerned renal unit. Recent technology in the design of ureteroscopes and their accessories may minimize injuries; especially if applied in teaching hospitals where the learning curve of URS is a demanding task

Role of fexible ureterorenoscopy in the management of lateralizing essential haematuria

Objective: To evaluate the role of flexible ureterorenoscopy in diagnosis and treatment of lateralizing essential haematuria. Patients and Methods: Twenty-three patients suffering from unilateral haematuria were included in the study and underwent flexible ureterorenoscopy. Their age ranged from 17 to 68 years (mean age: 36 years). Unilateral gross haematuria was demonstrated cystoscopically. The patients were subjected to a careful history taking; full laboratory and radiological investigations. However; we failed to localize the cause of haematuria in the patients included in the study. This necessitated flexible ureterorenoscopy on the affected ureterorenal unit. Results: The collecting system was inspected in 21/23 patients. Discrete lesions were identified in 11 patients (haemangioma on a renal papilla in six; small vascular lesions in three; a small calculus in one and a small papillary growth in one). Non-specific abnormalities (erythema of the infundibulumor abnormal configuration in the renal papilla) were found in six patients. No lesion was detected in 4 patients. Patients with non-specific abnormalities were biopsied and coagulated. The remaining 11 patients with discrete lesions underwent laser fragmentation of the calculus; nephroureterectomy for the papillary transitional cell carcinoma (TCC) and 9 patients underwent fulguration with or without biopsies. The haematuria resolved in all patients with discrete lesions. Patients with non-specific abnormalities had a poor outcome in our series; since all had recurrent or persistent bleeding. Follow-up ranged from 6-18 months (mean 9 months). Conclusion: Flexible ureterorenoscopy can be of value in the diagnosis and treatment of lateralizing haematuria. Patients with discrete lesions respond well to endoscopic treatment (electrocoagulation)

The management of operative urethral injury an experience with ten patients at Muhimbili Medical Cenntre

10 patients were treated at Muhimbili Medical Centre (MMC) for operative injury of the ureter following gynaecologic surgery. 7 were referred from up-country while three sustained injury during operation at MMC. The age range was 27 to 52 years with a mean of 36.5 years. Abdominal hysterectomy was the operation at which the ureter was most commonly injured. Only two of the injuries were discovered interpretively; a trend common to most series. Ureteric re-implantation or end-to-end anastomosis were performed according to the circumstances; with good results in all patients. The main shortcoming was prolonged delay before treatment in the majority of patients. A ureteric catheter inserted cystoscopically before operation; avoidance of excessive dissection of the ureter; constant consciousness about the possibility of urethral injury during abdominal and pelvic surgery and an intravenous urogram (IUV) in cases where difficulties are anticipated are useful preventive measures