Childhood nephrectomy indications: a changing profile

To assess the changing profile of children's nephrectomy indications in the south of Tunisia during the last two decades. There were 94 children who underwent nephrectomy between 1982 and 2007. They were classified into two groups. The first group included 55 out of 511 hospitalized children between 1982 and 1994, the second included 39 Out of 382 hospitalized children between 1995 and 2007. K2 [Chi-squared] test was used for this statistical analysis. A P value of<0.05 was considered statistically significant. The average was 7. Pathologies leading to nephrectomies were dominated in both groups by 3 main aetiologies: urolithiasis [42.5%],Wilm's tumors [21.3%] and pelvi-ureteric junction [13.8%]. While in the first group, urolithiasis was found to be the major indication of nephrectomy [54.5%, p<0.05], in the second group, kidney tumors had become the major indication [33%, p<0.05] followed by urolithiasis [25.6%]. So, the rate of nephrectomies performed due to urolithiasis had clearly decrease [P=0.005], but there were no statistical differences observed between the rates of nephrectomies performed due to tumors or upper urinary tract malformations in the two groups. The profile of children's nephrectomy indications in Tunisia stretches currently to be similar to the one of the industrialized countries, with regression of evolved kidney lithiasis leaving place to the tumorous pathologies,because of early detection, improvement and appropriate treatment of urinary lithiasis

[Appendiculoureteroplasty: about 6 cases]

Through this work we want to specify the place of ureteroappendiculoplasty as an important technical procedure for ureteral substitution. Between January 1997 and September 2002, 6 patients had an appendiculoureteroplasty. four women and two men with a mean age of 37 years [range 12 to 55 years] had a lesion of the right ureter. The decision is use the appendix was taken preoperatively in front of the difficulties associated with other procedures. The mean length of ureteral loss was 12 cm [6- 15 cm], the pelvic portion of ureter was more damaged than other segments [4 cases]. The appendix was suspended between the 2 ureteric extremities in 2 cases and between the ureter and the bladder in 4 cases. After a mean follow-up of 3 years [1 - 5 years], we noted a recovery of the kidney function in all cases. auto transplantation of the appendix can be considered a simple procedure that allows sometimes to reestablish the continuity of the ureter with good results