[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.

[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)

[The role of foetal surgery in urology (author's transl)]. / Place de la chirurgie foetale en urologie.

The authors report a brief experimental study showing that cystostomy performed in utero perfectly prevents, at least in the animal, deterioration of the urinary tract after urethral ligation. In the light of this experimental finding, the authors raised the question as to whether there is not a place for such bypass urinary surgery in utero in the humans. Indications would be highly obstructive forms of valves of the posterior urethra, treated in utero by cystostomy and, secondly, severe obstructions of the excretory system which could be temporarily bypassed by pyelostomy. This risks are described, but the possibility of such surgery is not excluded.

[Comparative experimental study of the renal consequences of vesico-ureteric reflux and of ureteric obstruction in the sheep foetus (author's transl)]. / Etude expérimentale comparée des conséquences rénales du reflux vésico-urétéral et de l'obstruction urétérale chez le foetus de brebis.

The authors sought to determine what links existed between foetal vesico-ureteric reflux and renal dysplasia. Using sheep with operation upon the foetuses in utero, at a fairly early stage of gestation, the following were obtained: 1) Foetal vesico-ureteric reflux by unilateral excision of a ureteric meatus. 2) Stenosis of the foetal ureter by ligation. In the first case, no renal dysplasia occurred. In the second case, dysplasia-type parenchymatous lesions were found. This led them to conclude that the direct relationship between isolated foetal vesico ureteric reflux created experimentally in a normal ureter (without any additional functional or organic obstructive factor) and renal dysplasia could not be demonstrated in the sheep foetus.

[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.

[Assessment of the renal consequences as related to operative technique in surgery for 190 staghorn or calyceal calculi. Comparative value of renal scintigraphy and intravenous urography (author's transl)]. / Evaluation du retentissement rénal en fonction de la technique opératoire dans la chirurgie de 190 calculs, coralliformes ou caliciels. Valeur comparée de la scintigraphie rénale et de l'urographie intraveineuse.

The authors have studied 86 patients with staghorn calculi who underwent preoperative quantitative renal scintigraphy. 50 of them (63 kidneys) had one or two follow-up scans between 1 and 9 years after the operation. These scintigraphic data were compared with those of I.V.U. These 50 patients had undergone surgery on 60 kidneys (12 pyelotomies only, 26 pyelotomies associated with limited nephrotomies, 18 extended nephrotomies and finally 4 bi-value nephrotomies). In 46 of these patients, the urine became definitively sterile and there was no recurrence of lithiasis in any of them. These quite exceptional conditions were such that it is possible to bear in mind only the operative technique in assessing the possible harmful consequences of each type of operation. The authors clearly show that the threat to function of the kidney which has been operated upon is more threatened when there has been a nephrotomy and when such a nephrotomy has been more extensive. A limited nephrotomy is associated with a mean loss of (% of renal function. Extended nephrotomies or more than 3 cm result in a loss of function of approximately 22%. Large bi-value nephrotomies result in a 36% loss of function. Simultaneous study of scintigraphic scans and I.V.U. revealed that a loss of 1 cm in height of the renal parenchyma corresponds to a functional loss of 10% as determined by scintigraphy. Of basic importance is the fact that the impairment caused by nephrotomies remains stable and does not worsen with the passage of time.