[Secondary megaureter: A rare complication of Deflux® endoscopic management of vesicoureteral reflux in children]. / Le méga-uretère secondaire : une complication rare du traitement endoscopique du reflux vésico-urétéral par Deflux® chez l'enfant.

Endoscopic management is the gold standard for symptomatic low-grade vesicoureteral reflux (VUR) in children. Deflux® (hyaluronic acid/dextranomer) injection is highly effective and has very few complications. We report on two cases of secondary megaureter after Deflux® injections. In the first case, a boy presented with Grade 4 VUR. He received a bilateral Deflux® injection with a total of three syringes. The postoperative ultrasound was normal. However, a check-up ultrasound 3 years later showed a significant ureteropyelocalyceal dilatation, with stasis and decreased renal function on scintigraphy, the reason why antireflux surgery (Cohen procedure) was performed. In the second case, a girl diagnosed with bilateral VUR at birth received bilateral injections with one syringe on each side at the age of 12 months. One month later, the ultrasound showed a dilation of the distal ureters (diameter of the right ureter, up to 10mm; left ureter, up to 6.7mm). The child underwent surgery 8 months later (Cohen procedure) because of iterative pyelonephritis and persistent ureter dilatation. Only one previous case has been described in the literature. In our experience, this complication has occurred only twice in 452 injections (4‰). In conclusion, endoscopic treatment with hyaluronic acid/dextranomer injection is a minimally invasive procedure that improves the situation in cases of VUR. It has few complications. Other than failure, there is a low risk of secondary expansion requiring, in our opinion, ultrasound verification over the long term.

[Review of clinical experience for a new preputioplasty technique as circumcision alternative]. / Retour d'expérience d'une nouvelle technique de préputioplastie comme alternative à la circoncision.

Surgery is required for phimosis with a contracted fibrous ring or when the medical treatment with steroids has been unsuccessful. Surgical teams often opt for circumcision when a conservative technique can be used. This surgery could have some psychologic consequences, and when the circumcision in not according to religious convictions, it cannot be live well for the patient and his family. Furthermore, some surgery procedures for prepuce conservation seem to give some unaesthesics aspects with cutaneous excess. The objective of this study was to evaluate our new preputioplasty technique according to the initial diagnosis (phimosis with scarred foreskin or long and narrow foreskin), in situation where circumcision is required currently. Outcome evaluated was: easy and painless foreskin retraction, absence of postoperative phimosis as well as cosmetic aspects of the penis. In this study, 90 children benefited from this technique and subsequent follow-up. The mean age was 7.9 years for the 32 children in the sclerotic phimosis group and 6.8 years for the 58 children in the long and narrow foreskin group. We observed complete foreskin retraction without any recurrence in 100% of children with a phimosis resistant to medical treatment which consisted of progressive foreskin retraction and application of topical steroids, with a mean postoperative follow-up of 1.4 years. Results showed an excellent cosmetic aspect of the penis with absence of enlarged foreskin in all our subjects. This study underlines the relevance of this surgical technique.

Use of cutaneous flap for continent cystostomy (daoud technique).

PURPOSE: We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy. MATERIALS AND METHODS: A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated. RESULTS: Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%. CONCLUSIONS: We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.

Nonoperative management of biliary tract fistulas after blunt abdominal trauma in a child.

Nonoperative treatment was carried out in a 12-year-old girl who presented with biliary fistulas after blunt abdominal trauma with hepatic injury. A computed tomography-guided percutaneous puncture showed biliary peritonitis and permitted the positioning of an efficient intraperitoneal drainage. Endoscopic retrograde cholangiography was very helpful for visualization and accurate localization of biliary injuries. This permitted positioning a nasobiliary drain to reduce intrabiliary pressure and to bypass a lesion of the common hepatic duct. This nonoperative management allowed healing of fistulas within 20 days, without bile duct stricture (noted on the follow-up intravenous cholangiogram 18 months later).

[Femoro-patellar instability in children and adolescents]. / Les instabilités fémoro-patellaires chez l'enfant et l'adolescent.

93 knees in 74 patients between 9 and 20 years of age were operated because of patello-femoral instability. In 76 cases, it was due to an intractable patello-femoral syndrome and in 17 cases one or several episodes of patellar dislocation had occurred. Treatment consisted, after failure of physical therapy, 14 times in a leavering of vastus medialis with a lateral capsular release and medial capsularrophy. In 71 cases it was associated to a medial transfer of the patellar ligament. Results were studied in 85 knees after an average follow-up of 6 years. 45 knees were completely symptomless, an excellent result. 34 knees remained with some kind of pain and 6 patellae redislocated. It is concluded that the transfer of the patellar ligament should be associated to the dynamic realignment achieved by the vastus medialis transfer for better results.

[Congenital vesicovaginal fistula. Commentary and review of the literature apropos of a case]. / Fistule vésico-vaginale congénitale. Commentaires et revue de la littérature á propos d'un cas.

A case of urinary incontinence through vesico vaginal fistula is related in a five year old girl. Its congenital origin is probable. The right ureteral orifice joins up with the fistula, in full duct. The corresponding kidney is hypotrophic and subjected to the vesico renal flow of the third degree. The incontinence disappears immediately. The literary studies have been analysed. Few are really vesico vaginal fistulas and few have a congenital origin.

[Open reduction by the Dunn technique in upper femoral epiphysiolysis. Report of 14 cases]. / Réduction sanglante selon la technique de Dunn dans l'épiphysiolyse fémorale supérieure. A propos de 14 cas.

Fourteen of Dunn's operations for slipped upper femoral epiphysis were analysed in their indications and their results in comparison with others series. The open operation of the femoral head is a good method for the chronic highest displacements. The notion of an acute displacement leads us to ask for a previous bone scintigraphy in order to make sure of the integrity of the vascularisation. Thus, there was no complication of necrosis in this surgery, but unfortunately, there were two chondrolysis and one mechanical accident.

[Adjusted cupula in the treatment of massive osteonecrosis of the upper part of the femur in adolescent children]. / Cupule ajustée dans le traitement des ostéonécroses fémorales supérieures massives de l'adolescent.

Six important necrosis of the apophysis of the femur were treated by arthroplasty with adjusted cup. This operation always made these hips painless, 5 times, the mobility was greatly improved. This a normal social life was quickly recovered. However, the distant future remains uncertain. With the exception of one immediate failure, one hip had to be reoperated, 8 years after the total arthroplasty.

[Surgical treatment of gastroesophageal reflux in the child using Dor's anterior partial fundoplication procedure. Report of 37 cases]. / Traitement chirurgical du reflux gastro-oesophagien de l'enfant par hémivalve antérieure. A propos de 37 cas.

A retrospective study of 37 children with gastroesophageal reflux, treated by Dor's anterior partial fundoplication procedure, objects a good clinical result in a rate of 95%. The late radiologic examinations confirm a good result in 84%, without gastroesophageal reflux or fundoplication alteration, with a mean follow-up of 6 years. The late efficiency of the partial fundoplication is assured by a safe fixation of the abdominal oesophagus and the partial fundoplication to the diaphragnatic crus.

[Liposarcoma in children. Apropos of 3 cases and a review of the literature]. / Liposarcome de l'enfant. A propos de 3 cas et revue de la littérature.

Liposarcoma is an uncommon tumour in childhood. Three cases are reported. Two patients remain alive and well without local recurrence or metastasis following the initial treatment, however one patient died as a result of direct tumour extension despite chemotherapy. A review of the literature revealed the following features: the extremity are the most common location, the predominance of myxoid histology and its best prognosis. The treatment is the complete surgical excision, the efficiency of radiotherapy or chemotherapy has not been formally proved.

[Disseminated osseous lymphangiomatosis. Apropos of 6 case reports]. / Lymphangiomatose osseuse disséminée. A propos de six observations.

Following six cases of disseminated bone lymphangiomatosis, the problem of potential haemorrhagic complications in the patients evolution has been focused. Consumption coagulopathy associated there, must be taken into account in view of therapeutic choices and vital prognosis evaluation.

[Unilateral hematocolpos in utero-vaginal duplication associated with homolateral renal agenesis. Apropos of 2 clinical case reports]. / Hématocolpos unilatéral sur duplicité utéro-vaginale associé à une agénésie rénale homolatérale. A propos de deux observations cliniques.

This is a report of two Cases of unilateral hematocolpos with ipsilateral renal agenesis in a bicornuate uterus with unilateral imperforate vaginal. The Symptoms, operative findings and surgical procedure are described. It is exceptional in the neonatal period to find an Hydro-Hematocolpos associated with complex genitourinary malformations. Easy diagnosis of Hydro-Hematocolpos and its effect on upper urinary tract are made by ultrasonography and intravenous urography.

[Neonatal urinary ascites caused by posterior urethral valves. Apropos of 2 cases]. / Ascite urineuse néonatale par valves de l'urètre postérieur. A propos de deux observations.

The authors report two cases of urinary ascites in neonates secondary to posterior urethral valves. They insist on the fact that the treatment is an emergency and should be as simple as possible. The resection of the urethral valves is done to allow a good bladder drainage. The leak of urine avoids the renal damage due to hydrostatic pressure. This explains the usual good prognosis of this pathology.

[Amniotic disease. Apropos of a series of 20 cases]. / Maladie amniotique. A propos d'une série de 20 cas.

Twenty patients with congenital constriction band syndrome are reviewed. Clinical manifestations and associated anomalies were analyzed with attention directed to distribution of the involvement and course of treatment. Constriction bands, amputation, and acrosyndactyly are the main clinical manifestations of the syndrome. Involvement of the distal portions of the extremity is most common, and the central digits are more frequently affected. Clubfoot deformity is the most frequently associated anomalies, those, associated, with deep constriction band at the below knee level are more severe and were due to compression neuropathy.