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Biomedical subjects

J Bruezière

Publications and source records attributed to J Bruezière.

At least 19 recordsLinked to original sources
PubMed1996

The value of split renal function in severe neonatal and infant pelviureteric obstruction managed by percutaneous nephrostomy.

A percutaneous nephrostomy (PCN) was inserted as part of the management in 17 newborns and infants with severe pelviureteric junction obstruction between 1981 and 1993. Nephrectomy was performed in eight cases and pyeloplasty in nine cases, successfully in six cases (mean follow-up: 7.7 years). PCN was useful for predicting that no non-functioning kidney on intravenous pyelography (IVP) in this series should have been preserved. Among the kidneys with a high excretion delay on IVP, PCN showed that only those that had a split creatinine clearance of more than 1 ml/min/1.73 m2, or theoretical clearance for age and weight of over 6%, should be preserved.

Creatinine↗
PubMed1995

[Uretero-colonic implantation in children. Late results].

An uretereo-colic anastomosis in children is performed in three occasions: 1) The trans-intestinal cutaneous ureterostomy (Bricker) has a low rate of complications concerning ureterocolic anastomosis. Nevertheless, occurrence of pyelonephrites may oblige to perform an anti-reflux procedure. 2) Implantation of ureters in the intestinal segment of an augmentation colocystoplastys in unusual; when necessary, this type of implantation is safe because colon is appropriate for an antireflux procedure. 3) Ureterocolic diversion (Coffey) is quite comfortable for patients. Risks of renal failure and of adenocarcinoma are minimal thanks to an annual control. Concerning exstrophy of bladder, it seems now that risk of infertility is lower for patients with an ureterocolic diversion than those with a genito-urinary reconstruction.

Acid-Base Imbalance↗
PubMed1991

[Genital prognosis of boys with bladder exstrophy or epispadias with incontinence. Apropos of 14 cases].

Bladder exstrophy and epispadias with incontinence are associated with urinary tract and genital anomalies. The genital and sexual aspects were studied in 14 adolescent or adult males (12 exstrophies and 2 epispadias). The appearance of the penis was satisfactory in fifty percent of cases. Erections were always preserved but normal ejaculations were present in only one half of cases. Fertility potential was reduced. The improvement of surgical technique, and especially penile lengthening, has greatly improved sexual intercourse for these patients.

Adolescent↗
PubMed1991

[Genital prognosis of girls with bladder exstrophy or epispadias].

The authors report ten cases of women with previous exstrophy of the bladder or epispadias with incontinence followed up to child-bearing age. Six of the ten females had urinary diversion and four retained their bladder and were continent. Three key aspects are considered: physical appearance of the external genitalia which was satisfactory in all cases; preservation of sexual function, known in only four of the ten cases and which was reported by these patients to be satisfactory, and finally, the ability to bear children. Three patients became pregnant resulting in four normal births (one patient had twins). Cesarean sections were recommended in patients with pregnancies at term. Cesarean should be performed systematically in patients with bladder reconstruction.

Adolescent↗
PubMed1990

[Obstructive anuria in children. Apropos of 22 cases].

The authors report twenty two cases of obstructive anuria observed in children. Causes are diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases in the immediate postoperative period (including 8 after antireflux surgery). In the emergency situation, treatment of obstructive anuria is based on urinary diversion ideally by percutaneous nephrostomy under ultrasonic control. But prevention is the best treatment of anuria: treatment of urinary tract infections resulting in renal stones, in case of tumor, ultrasonographic survey of chronic upper tract dilatation: rigorous atraumatic operative technique avoiding any oedema.

Adolescent↗
PubMed1990

[Obstructive anuria in children. Apropos of 22 cases].

The authors report twenty-two cases of obstructive anuria observed in children. Causes were diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases occurred immediately after an operation (including 8 after antireflux surgery). Emergency treatment of obstructive anuria is based on urinary diversion, ideally by percutaneous nephrostomy under ultrasonic control. However, prevention is the best treatment of anuria: treatment of urinary tract infections resulting in renal stones, ultrasonographic monitoring for chronic proximal urinary tract dilatation in tumors: rigorous atraumatic operative technique avoiding oedema.

Adolescent↗
PubMed1990

[Failures observed after repair of the pyeloureteric junction in children based on a series of thirteen cases].

We report a series of 13 infants with failed surgery for pyeloureteric junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either refashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ. Of the 258 surgically treated infants, 232 (90%) had a post operative course without complication or need for reoperation. The failure rate was significantly higher in infants operated before the age of 4 months (8/65: 12.3%) when compared with those over 4 months of age (5/193: 2.59%). The use of postoperative drainage via a nephrostomy significantly reduced the percentage of early complications (e.g. fistula) but did not affect the final failure rate. The severity of the obstruction at presentation correlated with a bad outcome after reoperation. Of the cases which resulted in failure after reoperation (7/258: 2.7%) all occurred in cases of severe obstruction with parenchymal damage. While the failure of surgery is often evident early (persistant fistula, urinoma, non-functioning kidney on IVP) this may only become obvious some years later. Reoperations were successful in half the cases irrespective of the time between the initial operation and the reoperation. Long term follow-up of all infants operated for PUJ obstruction is recommended.

Adolescent↗
PubMed1989

[Failures observed after repair of the pyeloureteral junction in children. Apropos of 13 cases].

We report a series of 13 infants with failed surgery for pyeloureteral junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either re-fashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ. Of the 258 surgically treated, 232 (90%) had a post operative course without complication or need for reoperation. The failure rate was significantly higher in infants operated before the age of 4 months (8/65: 12.3%) when compared with those over 4 months of age (5/193: 2.59%). The use of postoperative drainage via a nephrostomy significantly reduced the percentage of early complications (e.g. fistula) but did not affect the final failure rate. The severity of the obstruction at presentation correlated with a bad outcome after reoperation. Of the cases which resulted in failure after reoperation (7/258: 2.7%) all occurred in cases of severe obstruction with parenchymal damage. While the failure of surgery is often evident early (persistent fistula, urinoma, non functioning kidney on IVP) this may only become obvious some years later. Reoperations were successful in half of the cases irrespective of the time between the initial operation and the reoperation. Long term follow up of all infants operated for PUJ obstruction is recommended.

Adolescent↗
PubMed1989

[Retrograde ejaculation following a Y-V plasty of the bladder neck carried out during childhood. Treatment using the Abrahams procedure].

Retrograde ejaculation of Y-V plasty of the bladder neck performed during childhood appears to be a rare complication. Based on a case treated with success, the authors stress the need for non-aggressive treatment of bladder neck disease in children (endoscopic radial incisions). The procedure proposed by J.J. Abrahams for the treatment of retrograde ejaculation (simple calibration of the bladder neck and posterior urethra) proves to be reliable, although recurrences may occur.

Adult↗
PubMed1989

[Urethral fistula following reconstructive surgery of hypospadias. Apropos of 34 cases].

Thirty-four children, ten of them coming from another Surgical Center, underwent repair for urethral fistula after hypospadias reconstructive surgery, over a period of three years (1985-1987). After the first operation, there was no recurrence in 59% (20 cases). Currently, all fistulas have been closed, except in 3 cases. Closure by direct suture was used in 30 cases (88%). The best results were observed with suture in three planes and without diversion, on an outpatient basis (91% of success for 12 cases). The Leveuf method is a safe operation for complex penile fistulas after repeated surgery.

Adolescent↗
PubMed1988

[Ureteropelvic junction syndromes: antenatal diagnosis].

Seventy-four hydronephrosis by uretero-pelvic obstruction, discovered by antenatal real-time ultrasound, have been managed on sixty-one children. Three groups, with a specific management, are distinguished. The minimal forms have been only watched over (15 cases). The average forms have been operated (49 cases); considering the results (3 immediate complications and 2 early stenoses), it seems better to wait for 4 months to operate and to place a drain in renal cavities. In major forms (silent kidney on IVP), the diagnosis and therapeutic management use the percutaneous nephrostomy (10 cases). The interest of antenatal diagnosis of uretero-pelvic obstructions is to allow to operate, not only before the renal deterioration emphasizes, but principally before septic complications.

Age Factors↗
PubMed1987

[Treatment,in girls, of ectopic ureters, due to duplication, using reimplantation of the single pathological ureter into the bladder].

Mostly the ectopic ureter belongs to the upper pole in urinary tract duplications. In the pelvis, the two ureters are clearly separated. The only dissection of the ectopic ureter is in no case dangerous for the ureter of the lower pole. Therefore the reimplantation of the ectopic ureter can be performed separately. This only reimplantation of the ectopic ureter has been performed 9 times, without any mortality nor morbidity. The scar is almost invisible and the child is cured without any risk for the upper pole and saving the whole of the renal parenchyma. If the upper pole is functional, which happened in 1/4 of the cases, this technique is the best way and the less dangerous to recovery.

Adolescent↗
PubMed1987

[Obstruction after uretero-vesical reimplantation in children. Apropos of 40 cases].

Fourteen cases of obstruction after ureteroneocystostomy in children have been cured by surgery between 1972 and 1986; nine patients were referred from outside our hospital. This failure as been observed after reimplantation of simple thin ureter (29 cases) megaureter (7) or duplication (4). The diversity of lesions, of which 52 percent were ischemic stenosis, required surgery without any preconceived idea. A new reimplantation is often necessary, usually with Politano-Leadbetter procedure, and, if necessary, with a hitch-bladder. The operation is successful in 85 percent of patients, but the result is uncertain when the operation is late or when the value of renal parenchymal is initially poor.

Anuria↗
PubMed1986

[Varicocele in the child and adolescent].

Based on a series of 31 cases of children and adolescents with varicocele, the authors stress the high incidence of left testicular atrophy (71%). Other authors have emphasised the almost constant presence of histological lesions which are generally bilateral. These findings suggest that the harmful action of varicocele on spermatogenesis is more marked in children and adolescents than in adults, encouraging early surgical treatments which is almost always effective.

Adolescent↗
PubMed1985

[Congenital diverticula and valves of the anterior urethra].

Basing themselves on fourteen personal cases, the authors propose a distinction between two types of congenital lesions obstructing the anterior urethra--valves and diverticula. The main difference between the two resides in the fact that, while diverticula develop outside the corpus spongiosum, the prevalvular distension, in the case of valves, is covered by it. Valves must be treated by endoscopic resection, and this procedure gave good results in all three cases in which it was followed. A surgical approach to a valve through the walls of the urethra involves a risk of late severe stenosis. Diverticula have been successfully managed surgically in a single operation by ablation followed by reconstruction of the urethra. Attempts to treat them by endoscopic resection of the anterior border of the diverticulum were unsuccessful. Three diverticula were non-obstructive, and a cowperian origin was probable in two cases.

Adolescent↗