[Tumors of the upper excretory urinary tract. A homogeneous series of 108 patients]. / Tumeurs de la voie excrétrice urinaire haute. Une série homogène de 108 patients.

In their study of a homogeneous series of 108 patients operated for a transitional cell tumor of the upper urinary tract, the authors emphasize the following points: --every third tumor has several foci, and it is very difficult to make a complete inventory of all tumoral foci before surgery; --the great majority of these tumors are unilateral. Bilateral recurrence following radical unilateral excision is quite exceptional; --low-grade superficial tumors virtually never invade the lymph nodes, and their prognosis is excellent as a rule; --grade III carcinomas area almost always infiltrating and present high risks of lymph node invasion. Lymph node involvement means that the evolution will be lethal in all cases. None of the patients having invaded lymph nodes survived; --metastases appear soon, usually within the first 24 months, but mainly between the 6th and 12th months following surgery; --20% of the patients in this series died of metastases; --the actuarial survival rate after 5 years is 68%.

[Extracorporeal shockwave lithotripsy in children]. / La litotricia extracorpórea por ondas de choque en el niño.

Upper urinary tract lithiasis is a rare condition in children in comparison to its incidence in the adult population. The distribution of lithiasis in children has been reported to be 56% for idiopathic lithiasis, 20% for metabolic lithiasis, and 25% for lithiasis associated with uropathy. Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for upper urinary tract calculi in the adult patient as well as in children after minor changes and complementary material had permitted the utilization of the Dornier HM-3 lithotripter in these small patients. The reported 3-month success rates range from 47% to 83%, according to the number of patients or kidneys free from calculi. The series reported in the literature have a mean of about 60% completely stone-free kidneys evidenced on the X-ray of the abdomen without preparation at 3 months. Its indications and results are comparable with those of ESWL in the adult. However, the long-term results have as yet not been evaluated and, to date, its hypothetical effects on renal growth or arterial pressure have not yet been elucidated.

[Anomaly of the pyelo-ureteral junction and antenatal ultrasonic diagnosis]. / Anomalie de jonction pyélo-urétérale et échographie anté-natale.

Over a period of five years, 40 cases of anomaly of the pyelo-ureteral junction were diagnosed ante-natally which subsequently required surgical intervention during the first year of life. The indication for the therapy was based on the degree of obstruction (IVU, DTPA scanning, Whitaker test), the thickness of the renal parenchyma (IVU, ultrasound) and, to a lesser extent, on calyceal dilatation. After a period of follow up ranging from 3 to 48 months (mean 16.8 months), good results were noted in 37 cases, there were two permeable junctions with poorly functioning kidneys and one obstruction which was successfully reoperated. These results suggest that intervention is preferable to surveillance at varying intervals for an undetermined period, where the risk of a sudden exacerbation is always possible.

[Value of extracorporeal shockwave lithotripsy in the treatment of urinary lithiasis in children]. / Intérêt de la lithotriptie extra-corporelle par ondes de choc pour le traitement de la lithiase urinaire de l'enfant.

We report our experience with extracorporeal lithotripsy (Dornier HM3) in a series of 26 children with a mean age of 11.6 years, treated for 3 1/2 years. 12 children (46%) had a previous history of calculi and 7 (27%) had already undergone surgery on the same side. Treatment requires two transducer investigations before lithotripsy. With the exception of minor modifications the technique is the same as in the adult. Three (9.7%) postlithotripsy complications were noted, requiring 2 drainage procedures to be carried out on the urinary tract. At 3 months, the success rate (no residual calculi on the plain abdominal film) was 60.7%. This study confirms the efficacy of lithotripsy in the treatment of urinary lithiasis in children.

[Surgical correction of intermittent vesico-ureteral reflux without radiologically detectable reflux]. / La correction chirurgicale des reflux vésico-urétéraux intermittents sans reflux radiologiquement décelable.

On the basis of a series of 62 children with no radiological evidence of reflux but with an abnormality of a ureterovesical implantation similar to that seen in children with radiologically detected reflux, the authors attempt to show that under certain precise conditions (presence of cortico-papillary renal lesions, recurrent episodes of acute pyelonephritis, even in the absence of renal lesions), the absence of radiologically detectable reflux is not sufficient to confirm the primary nature of pyelonephritis. The sub-mucosal course of the ureters was found to be short in all of these children, and anti-reflux surgery was carried out on one or both sides according to whether the abnormality of uretero-vesical implantation was uni or bilateral. In this small selected group, clinical and bacteriological results were similar to those obtained by anti-reflux surgery in children with radiologically detected vesico-renal reflux.

[Urinary diversions and intestinal grafts in renal transplantation in children. Report of 8 cases]. / Dérivations urinaires et greffons intestinaux en transplantation rénale chez l'enfant. Rapport de huit cas.

In a series of 400 transplantations, 8 children presented a severe lesion of the lower urinary tract requiring an intestinal graft to divert the urine or to replace the useless bladder: 4 cases of posterior urethral valves and 4 cases of neurogenic bladder. Four permanent urinary diversions and 4 bladder enlargements, including 3 temporary diversions, were performed. The sigmoid colon was used in 5 cases and the ileum was used in 3 cases. The preparation of the intestinal graft was always performed prior to the transplantation. The uretero-intestinal anastomosis included an antireflux device in 3 of the 8 cases. There were no deaths in this series. Three occlusions and 2 lymphoceles occurred in the immediate post-transplantation period, but were corrected by re-operation. Two cases of calculi occurred in the long term, one of which required operation. Moderate stenosis of the renal artery in one case resulted in systemic hypertension which was well controlled by medical treatment. An episode of acute pyelonephritis resolved rapidly with antibiotic treatment. Two cases of acidosis were corrected by salt supplementation. There was one case of early graft rejection on the 15th day and a delayed rejection after 18 months, leading to removal of the transplant. At the present time, 6 renal grafts function normally (75%) with a follow-up of 1 to 8 years.

[Does the antireflux operation promote growth of the kidneys? Apropos of 65 surgically treated children with a minimal follow-up of 4 years]. / L'opération antireflux favorise-t-elle la croissance des reins? A propos de 65 enfants opérés avec un recul minimum de quatre ans.

A study in 65 children followed up over at least 4 years after Cohen's operation evaluated renal growth rate using Eklof and Ringertz method. Analysis showed that: small kidneys with corticopapillary lesions were all atrophied; hypertrophic kidneys remained hypertrophic or were within a normal growth rate range; normal size kidneys never hypertrophied but atrophied in 13.5% of cases; the presence of corticopapillary lesions multiplied the risk of degradation of a normal size kidney by a factor of 5.5. These findings are in concordance with documented data, only Willscher et al finding accelerated renal growth rate after surgical relief of reflux.

[Surgical complications of renal transplantation in children. Retrospective study of 372 cases]. / Complications chirurgicales de la transplantation rénale chez l'enfant. Etude rétrospective de 372 cas.

On the basis of a personal series of 372 cases of renal transplantation performed in children, half of whom presented congenital urinary tract malformations, the authors report 110 complications (29.6%). The most frequent complications were urological (14.2%), consisting essentially of fistulae (8.9%) and stenoses (3%). These were followed by vascular complications (6.4%) generally in the form of stenoses (4.8%) and rarely thromboses (1.1%). The authors also report the various local complications which were infectious (wall abscess, suppuration of the renal compartment), haemorrhagic (haematomas) or stones (stones forming on non-resorbable sutures) as well as 5 cases of lymphocele. The prophylaxis of these complications depends on the care taken in collection of the graft (en bloc removal of both kidneys), the restoration of the continuity of the urinary tract (as much as possible Lich-Gregoire extravesical uretero-vesical reimplantation), the vascular anastomoses (vascular dissection limited to a strict minimum), the choice of suture material (resorbable synthetic suture material) and the prevention of infection by systematic pre-, intra- and post-operative antibiotic therapy.

[Use of the intestinal graft in renal transplantation in children and adults]. / L'utilisation du greffon intestinal dans la transplantation rénale chez l'enfant et l'adulte.

Intestinal grafts as a means to external shunting of urine during renal transplant operation were described by W.D. Kelly as early as 1966. Since then 80 cases have been reported in the Anglo-Saxon literature. A total of 68 well-documented cases showed functional kidneys in 52%, complications in 42% and a 13% mortality rate. Between 1973 and 1985, of 400 renal transplant operations in children, an intestinal graft was used in 8 cases (2%) to provide 4 definitive external diversions and 4 enlargements or replacements of bladder. Indications for use were neurological bladder and posterior urethra valves. In all cases the graft was prepared before transplant operation. Enlargement of bladder requires good cervico-urethral function determined by previous study of a generally nonfunctioning bladder distal to an cutaneous ureterostomy. To avoid post-transplant urological effects the graft for enlargement or replacement is opened temporarily on to skin and closed several months after grafting. Follow up for 2 to 8 years showed 6 kidneys functioning normally, and 3 enlarged or replaced bladders out of 4 currently closed functioning satisfactorily. The 2 lost kidneys were rejected 2 weeks and 2 years respectively after the graft operation. There was no mortality or urological complication. The only surgical complications related to the intestinal graft were 3 early-onset occlusions treated successfully. Calculi formed in 2 cases, one being eliminated spontaneously at an early stage and the other, of late onset, requiring two operations. Metabolic or infectious complications were benign.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vesico-ureteral reflux in adults. Apropos of 103 cases]. / Le reflux vésico-urétéral de l'adulte. A propos de 103 observations.

Case reports of 103 adult patients operated upon for vesicorenal reflux are reviewed. The majority of the patients (94%) were women, and clinical signs appeared initially after puberty in half of these, mainly as fever, abdominal pains and pyuria. Twelve of the 25 women known to have children had had serious septic accidents during pregnancy. Only 11% had two normal kidneys, 50% having bilateral and 39% unilateral kidney lesions. Of the total studied, 70% of kidneys had corticopapillary lesions, while 35% were smaller than normal. The average length of the submucous trajectory of a refluxing ureter was 3.5 mm, 95.5% of kidneys with corticopapillary lesions having a ureter ending in a short submucous trajectory (average: 3.7 mm). Of the 156 ureters operated upon by antireflux advancement, stenosis developed in 2 and residual reflux in 9, 7 of these latter corresponding to exclusively transvesical ureteral dissections. Global efficacy was 73% for this type of surgery, with 7.5% poor and 19.5% doubtful results. Conclusions drawn from this analysis were: the adverse effects of reflux during pregnancy (one out of 2 cases), the frequency of renal lesions in adults (35% of small kidneys and 70.4% of kidneys with corticopapillary lesions), the short submucous portion of these ureters--its length did not exceed that found in children with reflux--perhaps there had not been intramural ureteral growth, and the efficacy of the antireflux operation if a wide extravesical dissection is performed before the antireflux advancement procedure itself.

[Adjuvant chemotherapy of infiltrating bladder cancer. A feasibility trial]. / Chimiothérapie adjuvante des cancers infiltrants de vessie. Un essai de faisabilité.

From January 1981 until December 1983, 51 patients have been submitted to total cystectomy for infiltrative bladder cancer, stages B2 C and D1 of the Marshall classification. They have be proposed in a trial of feasibility with adjuvant chemotherapy using Adriamycin and Cis Platinum. 24 patients have been excluded, 17 because medical contraindications, 5 because they were foreigners, 3 because they refused the therapy. 27 patients have received the chemotherapy. In 5 patients the treatment has been interrupted before the completion of 6 cycles. The results show the feasibility of a trial with adjuvant chemotherapy. The theorical rationale and the methodology are discussed.

[Direct cutaneous ureterostomy: a new technic. Preliminary results]. / L'urétérostomie cutanée directe: une nouvelle technique. Résultats préliminaires.

A current problem in urology involves the search for a method of high urine bypass which combines simplicity of application with therapeutic efficacy. A new technique of direct cutaneous ureterostomy is described which is applicable to both narrow and dilated ureters, and which prevents stenosis without catheterization. The originality of the method resides in the association of two previously described artifices. The first is related to the parietal crossing and involves interlocking of the aponeuroses of the external oblique and transverse abdominal muscles with resulting displacement of the internal oblique muscle fibers outside of the parietal course of the ureter. The second artifice concerns the ureterocutaneous anastomosis, with the formation of a skin flap in V sutured to the terminal portion of the axially incised ureter, the point of the V being attached to the apex of the incision. Ureteral vascularization must be respected and a sufficient length of ureter used to ensure anastomosis without traction. An indwelling ureteral catheter is maintained for one month, followed by urographic and ultrasonographic surveillance at progressively increasing intervals. This operative procedure was used in 23 patients (21 men and 2 women), age 48 to 74 years, with bladder cancer necessitating total enlarged cystoprostatectomy. Bilateral cutaneous ureterostomy was performed in 19 cases, and the unilateral operation (single kidney) in 4 patients. Of the 41 ureters on which a bypass was performed, 31 were initially narrow and 10 dilated. Overall results for 41 ureters showed that 34 (82,9%) were permeable after 18 months, a catheter having to be maintained in 7 cases only (17,1%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Experimental study in the urinary tract of a new smooth surface absorbable synthetic monofilament (author's transl)]. / Etude expérimentale au niveau de l'appareil urinaire d'un monofil synthétique résorbable à surface lisse.

The authors used 27 dogs to test the behaviour in the urinary tract of a new synthetic monofilament and absorbable suture material. Polydioxanone (PDS). The experiment was aimed at assessing the strength, ease of use, rate of absorption and lithogenic power of this material, in comparison with chromic catgut. Four loops of each material studied were inserted in the bladder, floating freely in the lumen. Absorption was evaluated by periodic cystoscopies. In the kidneys, one suture of each type was inserted into the excretory cavities by the transparenchymatous route. Development of a possible calculus was sought by urography and repeated plain X-rays of the abdomen. All the animals were killed at 6 months and routine pathological study made of the kidneys and bladder. Certain dogs were infected with proteus and subjected to fluid restriction. The lithogenic power of PDS and chromic catgut appeared to be identical. In contrast with urine, the absorption of chromic catgut by enzyme digestion was more rapid than that of polydioxanone by hydrolysis. By contrast, within the thickness of the tissues, absorption of the latter was more constant and more complete than that of chromic catgut. Polydioxanone caused a less marked tissue inflammatory reaction than the former. Scars were of equal strength. Finally, PDS suture material appears to be remarkably strong and very much easier to use than woven absorbable synthetic materials currently in use.