[Malformations associated with testicular ectopy].
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Biomedical subjects
Publications and source records attributed to J Brueziere.
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The authors study fifty five cases of reflux, involving ninety five reno-ureteral units, with a followup of then to eighteen years. The renal injuries were invariably secondary to an infection. The fate of pyelonephritic kidneys was dramatic--out of a total of fifteen, only five showed normal growth, and the other ten showed a standard deviation of at least - 4; surgery does not prevent an adverse evolution. The lesions may appear postoperatively during the period of medical treatment (4 out of 70 in this series). Non-infected refluxes are not harmful, because of the possibility of compensating hypertrophy. Unsuccessful surgery does not compromise the fate of the kidney, because of early reoperation. The main factor in the prognosis is effective treatment as soon as the symptoms appear.
Based on a personal series of 310 observations, the authors have studied the presenting signs, the etiology, the urinary bacteriology and the localization of the stone in children with urolithiasis. Urinary tract infection is the presenting sign in 55% of the cases, hematuria in 23% and abdominal pain in 20%. Urinary malformation is associated in 26% of cases, whatever the age at diagnosis. The urinary bacteria found in 55% of cases is Proteus. Localization was in the kidney in 228 cases, in the ureter in 71 cases, the bladder in 45 cases and in the urethra in 5 cases.
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In 22 cases we observed the association of post traumatic intra and retro peritoneal bleeding the latter due to kidney rupture. In such cases the usual policy consists in treating the abdominal visceral lesion first and post pone the management of the kidney rupture. In 13 cases we decided to undertake simultaneous surgical treatment of the abdominal and kidney lesion. The preoperative diagnosis was established by combination of exploratory peritoneal dialysis and I V P. The surgical exploration was achieved by means of medial incision. In 6/13 cases it disclosed kidney lesions which necessitated immediate nephrectomy. Our experience shows that one stage surgical procedure is beneficial to the patients.
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Urine incontinence of sphincteric origin in the little girl can have several origins: epispadias, hypospadias, bilateral single ectopic ureters, isolated sphincteric agenesis, iatrogenic lesion of the sphincter, complications of ureterocele. Creation of a new urethra alone, whatever the technique used, seldom restores continence. In addition, the proximal urethra is supported by means of an aponeurotic flap, the results improve considerably: in this series, 6 good results out of 7. In surgical correction of epispadias in girls, the author recommends combining the technique described by Islam and supporting the bladder neck by the Goebbel Stoeckel's technique.
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