[External sphincterotomy using bipolar vaporisation in saline. First results]. / Incontinentation par vaporisation bipolaire du sphincter externe de l'urèthre. Premiers résultats.

OBJECTIVES: The aim of this study was to assess the feasibility, efficacy and tolerance of external urethral sphincter vaporization in saline for treating detrusor-sphincter dyssynergia. MATERIAL: Between 2009 and 2011 a monocentric prospective study of ten men mean age 58±9 years with neurogenic detrusor-sphincter dyssynergia was carried out. Preoperative evaluation included kidney ultrasound scan, 24-hour creatinine clearance, urodynamics, retrograde and voiding urethrocystography and an at least 6 months temporary stent sphincterotomy. Postoperative assessment was composed of an ultrasound scan post-void residual volume measurement when the urethral catheter were removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and a flexible cystoscopy at 1 year. RESULTS: At the catheter removal, eight patients emptied their bladder at completion, a supra-pubic catheter was temporary left in one case and a patient had a permanent urinary retention. For a mean follow-up of 22±11 months, eight patients emptied their bladder at completion and two had a complete urinary retention related to a detrusor underactivity. An orchitis occurred in one case 1 month after the procedure and an urethral stricture in four cases in 12.75±5.68 months on average. CONCLUSION: External urethral sphincter vaporisation saline was feasible and efficient for treating detrusor-sphincter dyssynergia but was associated with a high risk of urethral stricture.

[Epidemiological description of patients with neurological conditions in kidney transplant recipients]. / Epidémiologie des patients neurologiques dans une population de transplantés rénaux.

OBJECTIVES: The aim of this study was to describe the epidemiology of neuropathic bladder in kidney transplant patients. PATIENTS AND METHODS: Patients with terminal chronic kidney disease related to neurogenic bladder were sorted out from a population of 1286 kidney transplant recipients operated between 1993 and 2008. RESULTS: Thirty-three patients, 26 men and seven women, mean age 46.9+/-12.4 years old at the transplantation time were found out. Neurological conditions were spinal dysraphism in 39.4% of the cases, brain injury in 18.2%, cerebrovascular accident in 15.2%, spinal cord injury in 12.2%, myelitis in 6%, congenital encephalopathy in 6% and Hinmann's syndrome in 3%. Mean time between the onset of the neurological disease and the beginning of the dialysis was 21.7+/-11.9 years. CONCLUSION: Prevalence of patients with neuropathic bladder in kidney transplant patients is 2.6%. Most frequent neurological conditions involved are spinal dysraphism and brain injury. The onset of the dialysis occurs 21 years on average after the diagnosis of the neurological disease in patients with mean age of 37.8 years.

[Long-term outcome of patients with renal transplant and neural tube defect]. / Suivi au long terme des patients transplantés rénaux ayant un dysraphisme spinal.

PURPOSE: To evaluate the long term outcome of renal transplant in patients with a neural tube defect causing voiding dysfunctions. PATIENT AND METHODS: Between 1993 and 2010, 18 cadaveric renal transplants were performed in 16 patients (5 females and 11 males) older than 15 years with a neural tube defect and voiding dysfunction. RESULTS: The patients had dialysis since the mean age of 27.4 and have been transplanted at the mean age of 32.2. The survival rate of the first kidney transplant was 93.75% at 1 year and 63.3% at 5 and 10 years respectively. With a mean follow-up of 6.67 years, 11 out of 16 first transplants remained functional (68.75%) The median survival of the first transplants was 13.52 years. At the end of the follow-up, 13 out of 18 transplants were still functional (72.2%). The mean serum creatinine level was 123.9 micromol/l with a mean glomerular filtration rate estimated by the simplified MDRD formula of 67 ml/min for the 13 still functional transplants. Before transplantation, 66% of patients had a neuro-urologic assessment versus 100% thereafter. CONCLUSION: Renal transplantation in patients with neural tube defect is feasible without surgical particularities to those of other renal failure causes. These type of patients represented less than 1% of the followed cohort with an average graft survival rate of 63.3% at five and 10 years. The median survival time of the first graft was 13.52 years.