Biomedical subjects
Publications and source records attributed to H Dodat.
A 16-day-old girl with Waardenburg syndrome type 1 presented with a right multicystic dysplastic kidney (MDK) and hydronephrosis in the left kidney. To our knowledge, such an association has not yet been reported and should be added to the list of MDK-associated genetic syndromes.
This review includes the description and treatment of the various malformations of the male internal genitalia of Wolffian origin. Congenital epididymal cyst is the most frequent anomaly; it is usually asymptomatic so that surgery is seldom necessary. Agenesis of the deferent is usually discovered during surgery for undescended testis and is frequently associated with a homolateral renal agenesis. Ectopia and duplication are other possible anomalies affecting the deferent. Seminal vesicle cysts is mainly discovered after puberty; pelvic pain and/or urinary symptoms are the main revealing signs. It is frequently associated with other uro-genital anomalies, mainly renal agenesis.
OBJECTIVES: To analyse embryological phenomena, in order to define a practical approach to management. METHODS: The authors reviewed the files of eight boys with an abnormality of Wolffian duct derived genital organs, consisting of three cases of vas deferens agenesis, two of which were accompanied by homolateral renal agenesis, one case of ectopic vas deferens with contralateral renal agenesis, three cases of duplicated vas deferens and one congenital seminal vesicle cyst with renal agenesis. DISCUSSION: Congenital malformations of the epididymis consist of cysts and agenesis or partial atresia. Cysts essentially raise a problem of differential diagnosis. Treatment is only required in the case of severe discomfort. Vas deferens agenesis is the commonest lesion, an incidental finding in children. An experimental treatment is proposed in adults. Duplications, interdeferential communications and deferentomegaly are much rarer lesions. Seminal vesicle cysts are well visualized by transrectal ultrasonography and should be treated surgically. Lastly, ejaculatory ducts may present urethroseminal reflux or may be ectopic. CONCLUSION: The possibility of absent or ectopic vas deferens should be considered in the case of unilateral renal agenesis. Vas deferens agenesis justifies examination of the contralateral side and investigation to exclude renal agenesis. Congenital cysts of the epididymis only require surgery when they are symptomatic. The presence of ipsilateral renal agenesis should be investigated in the case of cystic dilatation of the seminal vesicle.
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A hydrocolloid dressing was compared to adhesive skin tapes on children's postoperative wounds. A total of 170 children of varying ages were randomised in two parallel groups, in nine centres of plastic, thoracic, gastrointestinal, urogenital and orthopaedic surgery. Skin closure was satisfactory in both groups, with 76 (89.4%) healthy closures without dehiscence in the hydrocolloid group and 81 (95.3%) in the control group; a relationship was found between partial closures/dehiscence and the type of surgical procedure. No product-related maceration, infection or adverse event was reported during the study and both groups showed very satisfactory cosmetic results.
BACKGROUND: Diphallia and penoscrotal transposition are rare, generally sporadic, abnormalities. CASE REPORTS: Case 1: A 2-1/2-month-old boy was admitted in hospital because he suffered from complete penoscrotal transposition, with moderate hypospadias for which he was operated on. Examination at the age of 6 years showed hypoplastic and dislocated patellae. Case 2: A 2-month-old boy, brother of case 1, also suffered from incomplete penoscrotal transposition, associated with diphallia but without double bladder, that was operated on. Ultrasonography at the age of 17 months showed absence of patellae. The sister of these two patients was normal but her mother displayed ambiguous genitalia with phallic structure located beneath partially fused labial folds. Her patellae were also absent. CONCLUSION: This is the first familial case of true diphallia associated to penoscrotal transposition. This abnormality is also associated to absence of patellae and seems to be dominantly inherited.
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This study of 785 cases of vesicorenal reflux in 494 children treated endoscopically over a 7-year period was designed to evaluate the results obtained with three products used successively: Teflon, collagen and Macroplastic. Following Teflon injection, despite a 90% short-term success rate, recurrent reflux was subsequently observed in 16.71% of the ureters reviewed. The failure rate was 52.63% after collagen injection and 11.77% after Macroplastic. After one or two injections, complete resolution of reflux was obtained in 48% of children treated with collagen, versus 85.72% with Teflon and 93.33% with Macroplastic. In one half of cases, failure was related to the quality of the product and its modifications after injection. The marked resorption of collagen accounts for the poor results despite the large doses injected. Apart from one case of partial resorption of Teflon paste, the failures with this product were due to lateralisation or secondary elimination of the product from the injection site due to its fluidity. Macroplastic, due to its higher viscosity and absence of retraction, currently provides the best results with doses of less than 0.20 ml in children.
The authors report their experience with surgical treatment of hypospadias about 557 cases. From 1974 to 1981, only 84 cases were cured by classical procedures (Mathieu, Van der Meulen, Perlemutter, Duplay-Fèvre, Leveuf-Cendron), sometimes with Cahuzac uretroplasty). The age when correction depended from the type of hypospadias and several times were after necessary. From 1981 to 1992, 463 cases were operated, always between 18 month to two years of age, with only one operative with therapeutic indications are actually such proposed: distal meatotomy or modified MAGPI procedure for glandular hypospadias; Duplay uretroplasty for coronal form; Mathieu or onlay island flap for anterior and medial penil types without curvature; Mollard or Duckett uretroplasty for penil forms with chordee; Then, for posterior types, complementary posterior Duplay uretroplasty, or vesical ou buccal grafts.
Based upon a 7 years personal experience and the results published in the literature, the author analyses the current knowledge on the endoscopic treatment of vesicoureteric reflux (VUR) in children. Teflon has been the most widely used product, with more than 6,000 subureteric injections during the last 9 years over the world, and a rate of successful endoscopic correction of VUR of approximately 85%. Despite the criticisms addressed to teflon concerning its carcinogenic potential and the risk of vascular migration, neither clinical manifestations related to lung, liver or brain migrations, nor carcinogenic degeneration have been so far observed. Ureteral stenoses has been the only rare complication (< 1%), leading to secondary surgical treatment of VUR with good outcome. Persistent or recurring VUR can always be surgically treated without particular difficulties. An alternative to teflon has been looked for in recent years. The results obtained with bovine dermal collagen are presently rather disappointing due to a high rate of failure. On the contrary the preliminary results obtained with injection of microparticulate silicone appear very promising: correction of VUR in over 90% of cases and good local tolerance adding to absence of carcinogenic and migration risks. Further trials and a longer evaluation period are necessary before to consider microparticulate silicone as the ideal product to be used in the endoscopic treatment of VUR.
220 distal hypospadias have been operated over a period of 10 years: 53 glandular, 144 coronal and 23 anterior penile subcoronal hypospadias with no chordee. Although with 131 MAGPI procedures we had only 3 urethral complications (one fistula, one total and one partial disunion), it does not seem to be a well adapted procedure for the correction of coronal and anterior penile hypospadias: the new meatus is not exactly apical, the glans remains short on its inferior side, and we often noticed a distal curvature at the end of the intervention. The urethroplasty technique that we performed 89 times avoids these disadvantages: the urethra is reconstructed in 2 layers as far as the summit of the glans according to Duplay's procedure, the urethrocutaneous adhesions are freed down the penis, the distal thin urethra is covered by an intermediate layer and the shortage of ventral skin is compensated for by the formation of a circular esthetic mucous annulus. There have been no complications with glandular hypospadias (7 cases), 4 with coronal hypospadias (64 cases) and 4 with anterior penile hypospadias (18 cases). While the MAGPI procedure remains an excellent technique for the correction of glandular hypospadias, the Duplay's procedure is better adapted for the correction of coronal hypospadias, in spite of the occurrence of more frequent (easily treated) fistula (6.25%). The juxta coronal position of some anterior penile hypospadias is still better repaired by the Mathieu's or the Snyder's procedures.
The author comments on the main aspects of the evolution of methods of diagnosis and treatment in pediatric urology during the past 20 years. In the field of diagnosis, ultrasounds have been a major break-through allowing early detection of uropathies and an easy supervision of their evolution. In the therapeutic field, improvements in surgical techniques and anesthesia have been numerous leading to both better results, and considerably reduced duration of hospitalization.
Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)
Three techniques have been developed for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. This multicenter retrospective study of 178 children who underwent surgery for posterior hypospadias was designed to compare the results achieved with these procedures. Free skin grafts (15 cases) resulted in the most frequent complications, and in particular the most severe strictures; in our opinion this technique should be abandoned. Pedicle preputial grafts (133 cases) gave the greatest number of successes from the outset, and should be preferred whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts (30 cases) were not as good as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position, and for children who have already undergone multiple operations.
Congenital megalo-urethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia or agenesia of spongy tissue. Two types are described, scaphoid and fusiform types, according to the presence or the absence of erectile tissue. Megalo-urethra is a rare condition, and 56 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.
Ureteropelvic junction obstruction in children: evolution of diagnosis and treatment. 180 hydronephrosis due to ureteropelvic junction obstruction in 162 patients have been referred to our hospital. The patients were all infants and children with an age ranging between 1 day to 15 years. Out of 9 abstinences (grade I or 11) and 7 nephrectomies for destroyed kidneys (3 of them after temporary nephrostomy), we performed 164 ureteropelvic junction resections and anastomosis, 51 of them with associated pyeloplasty. The use of a stenting catheter passing through the anastomosis and coming out as a nephrostomy in 81 cases gave us 5 mechanical complications while the complete absence of drainage gave only 3 fistulaes. 2 of these fistulaes had a spontaneous rapid healing after endoscopic ureteral catheterism. Out of 160 follow-up cases, we reoperated 6 failures with success: 5 ureteropelvic reanastomoses and one ureterocalycostomy. This study shows us that the early treatment due to antenatal ultrasound diagnosis improves the prognosis. Renal scanning with furosemide test permits to specify the surgical indication in limited cases and the presence of a residual obstruction in case of persistance of renal pelvis dilatation in the postoperative period. The posterior approach and the absence of internal drainage simplify the treatment, improve the patient comfort and limit the hospitalisation period to 5 days.
Endoscopic subureteral injection of Teflon was performed in 113 children (217 ureters) to correct all types of vesicoureteral reflux. In all cases immediate disappearance of the reflux was noted on an operative cystogram. Two-hundred and thirteen ureters were controlled at 1 month. Reflux had disappeared in 85.11% of the cases after a single injection and after 2 injections in 89.3% of the cases. The results remained stable in 93.22% of the cases at 1 year. Most relapses were explained by an insufficient quantity of Teflon and difficult anatomical conditions. Indications for this technique and the safety of the paste used are discussed.
17 centers answered an inquiry on the endoscopic treatment of vesicoureteral reflux. 844 children were reviewed representing 1,290 ureters treated by endoscopic injection of Teflon. The first results in cases of primary or secondary reflux showed a success rate of 82.3%. All authors report low morbidity and excellent tolerance of this technique. In view of the long-term prognosis, these results should be reanalyzed, the median follow-up presently being 1 year. The next logical step should be the development of implant material with a higher biocompatibility but the identical physical properties as Teflon.