[Endoscopic realignment versus delayed urethroplasty in the management of post traumatic urethral disruption : report of 30 cases]. / Le réalignement endoscopique versus urétrorraphie terminoterminale tardive dans le traitement des ruptures post-traumatiques de l'urètre : Notre expérience à propos de 30 cas.

BACKGROUND: Post traumatic posterior urethral disruption is a common condition, its treatment is controversial. AIM: To assess the long term results of endoscopic realignment compared with delayed urethroplasty, in the management of post traumatic urethral disruption. METHODS: Between February 2002 and March 2009, 30 patients have been operated for post traumatic posterior urethral disruption. 20 have had a primary endoscopic realignment and 10 have had delayed urethroplasty. Analysis of the results took into consideration, the quality of micturition, the continence and the erectile function. results: Median follow-up was 21 months, good results were recorded in 13 patients among the group of realignment (65%). 0f the failure cases (7), 3 underwent urethroplasty and 4 were managed by endoscopic treatment. Endoscopic realignment could avoid open surgery in 17 patients (85%). Among the 10 patients that underwent urethroplasty, 7 patients had good results (70%). No patient had urinary incontinence. A post operative erectile dysfunction was noted in one patient from the realignment group and two other patients from the urethroplasty group. CONCLUSION: The endoscopic urethral realignment could be used as a primary therapeutic management of post traumatic urethral disruption. It could be recommended for recent trauma, between one and two weeks, and for patients that can support exaggerated lithotomy position. Endoscopic realignment is an effective safe therapeutic mean that does not contraindicate a second-line urethroplasty.

The long-term results of laparoscopic retroperitoneal pyeloplasty in adults.

OBJECTIVES: To report the long-term outcome of laparoscopic retroperitoneal pyeloplasty (LRP) in adults. PATIENTS AND METHODS: Thirty patients underwent LRP for primary pelvi-ureteric junction obstruction (PUJO). Anderson-Hynes dismembered pyeloplasty was used in 28 patients and a Foley Y-V pyeloplasty in two. A JJ stent was inserted antegradely during the procedure. Patients were reviewed at 1 month after LRP for stent removal, and then at 6 and 12 months routinely, using excretory urography. RESULTS: The mean patient age was 29.7 years, with a female predominance of 60%. Conversion to open surgery was mandated by dense adhesions secondary to previous pyelonephritis in three patients, and difficulty in suturing in one. The mean (range) operative duration was 228 (190-280) min. There was a crossing vessel in 11 patients and it was not transposed in any. The mean hospital stay after LRP was 4.2 days. The mean (range) follow-up was 60 (29-106) months. Of the 26 patients who had complete laparoscopic procedures, 23 had no evidence of obstruction on long-term postoperative intravenous urography and/or diuretic renography. CONCLUSION: LRP combines the high functional success rate of open pyeloplasty in the long term and the minimally invasive morbidity of laparoscopy.