Endovascular management of uretero-Iliac artery fistula.

Uretero-Iliac artery fistula (UIAF) is a rare condition in vascular surgery, its prognosis remains poor with a high mortality, requires rapid multidisciplinary diagnosis and treatment. We report the case of an uretero-Iliac artery fistula in a 65-year-old patient who underwent total pelvectomy with trans-ileal cutaneous ureterostomy (Bricker), followed by pelvic radiotherapy, and placement of a single J ureteral stent, diagnosed by abdominal and pelvic CT, and treated by endovascular approach.

Detection of bladder dysplasia using 5-aminolaevulinic acid-induced porphyrin fluorescence.

OBJECTIVE: To report results of a clinical investigation on the detection of bladder dysplasia and in situ carcinoma by using fluorescence induced by 5-aminolaevulinic acid (ALA). PATIENTS AND METHODS: The study included 50 patients with a primary bladder lesion, who had a bladder instillation of 50 mL of 3% ALA solution >or= 1 h before transurethral resection of the tumour. Random biopsies were taken using white-light cystoscopy, then using blue light to induce fluorescence; positive zones were noted and biopsied. The primary lesion was then resected. The frequency of dysplasia detected by ALA-induced fluorescence was evaluated, as was the risk of recurrence with a follow-up of >or= 2 years. RESULTS: In all patients the tumours were positive; in 21 fluorescence distant from the tumour was detected. The pathological report of the biopsies showed 11 cases of dysplasia, six of carcinoma in situ and four of inflammatory lesions. In 29 patients there was no fluorescence and quadrant biopsies were normal in all but three with moderate dysplasia. Within the minimum follow-up patients with bladder dysplasia detected by ALA-induced fluorescence had a higher risk of recurrence. CONCLUSION: ALA-induced fluorescence of the bladder significantly enhanced the detection of dysplasia and in situ carcinoma. However, this technique requires further investigation using well-characterized instrumentation and study protocols to determine any effect on treatment choice.

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.

[Post-traumatic complication of trans-appendiceal cystostomy: urinary peritonitis]. / Une complication post-traumatique de la cystostomie trans-appendiculaire: la péritonite urinaire.

Two children who had undergone a transappendicular urinary diversion (type Mitrofanoff) developed bladder rupture, one following abdominal trauma, 4 months after the operation and the other following traumatic self-catheterization at 4 years. The clinical history and standard radiological examinations (ultrasonography, cystography) confirmed the diagnosis of urinary peritonitis. Emergency surgical repair was possible in both cases with an uneventful postoperative course. This serious and rare complication requires emergency surgery and justifies rigorous selection of children suitable for this type of diversion giving preference to increased bladder neck resistance over bladder neck closure.

Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization.

BACKGROUND: The order of revascularization in human liver grafts is still discussed. This study tries to answer this question in terms of hemodynamic data. STUDY DESIGN: Fifty-nine patients were randomized in this study to compare hemodynamic data just before and 15 minutes after revascularization of liver grafts in relation to first hepatic artery (n = 29) or first portal vein (n = 30) revascularization procedure. RESULTS: Hemodynamic variations were significantly greater in the portal vein group than in the hepatic artery group in terms of mean arterial pressure, cardiac index, central venous pressure, pulmonary capillary pressure, and systemic vascular resistance. The latter decreased from 741.8 +/- 390.3 to 659.9 +/- 411.1 dynes/ cm5 (NS) in the hepatic artery group versus 807.7 +/-336.7 to 439.7 +/- 215 dynes/cm5 (p < 0.05) in the portal vein group. Clinical results and postoperative complications, graft characteristics, patient survival, and graft survival were not significantly different between the groups. CONCLUSIONS: Initial arterial revascularization of the liver graft leads to a more stable hemodynamic profile during revascularization of the liver graft after vascular unclamping. This technique is always feasible and has become our reference procedure.

[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.