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L Falandry

Publications and source records attributed to L Falandry.

34 records · Page 2Linked to original sources
PubMed1992

[Ureterovaginal fistulas: diagnosis and surgical tactic. Apropos of 19 personal cases].

Personal experience of the treatment of 19 ureterovaginal fistulae, observed from september 1987 to june 1991 on 17 patients in Africa is described and analysed. Occurring after gynecological or obstetrical surgery, the main cause is hysterectomy (82.3%). Elements for diagnosis were: the appearance of a urine leak, which in most cases came rapidly, echography, and most important, intravenous urography (IVU). Surgical management in all of the cases was mainly aimed at conservation. One end-to-end anastomosis and 18 cuff reimplantations were performed, combined in 2 cases with a sub-mucus tunnel (Politano), in 14 cases combined with a tubular Boari bladder flap (wherein 1 case was bilateral), 3 combined with a bladder psoas hitch and 2 with an isolated ileal graft (ileo-ureterocystoplasty). One case of vesicouterine fistula and 4 associated vesicovaginal fistulae benefited from a simultaneous surgical operation. In this study of 17 patients treated, except for one patient deceased 14 months following a neoplastic recurrence, the results were excellent. 16 patients were cured. Follow-up extended to more than a year and have shown the perfect conservation of the excretory ducts in all of the cases studied. The cuffed ureterovesical reimplantation combined with a tubular bladder plasty definitively seem to be a most reliable management technique for all ureter injury encountered. While allowing the preservation of the kidney located just below, it has, in particular, prevented ureter stenosis. If the use of simpler methods (psoas bladder hitch) may be sufficient for some cases, the use of more complex method (ileoureterocystoplasty) for other cases, may be indispensable.

Adolescent↗
PubMed1992

[Treatment of post-partum urogenital fistulas in Africa. 261 cases observed in 10 years].

A homogeneous series of 261 post-partum urogenital fistulae treated over the last ten years in Africa by the same operator is analysed. Mostly occurring in young, primiparous women in a rural environment, the predominant cause was neglected dystocic delivery in the bush (65.5%). The fistula was traumatic in 27.9% of cases and secondary to hysterectomy in 6.8%. 247 patients underwent surgical repair. The choice of repair procedure, generally performed via the transvaginal route (92.3%), was based on the anatomical classification of the various lesions into three groups of indications: Group I: simple fistulae (98), in which surgical treatment consisted of closing the fistula orifice by simple separate suture of the bladder and vagina, generally followed by success. Group II: more difficult fistulae (109) with severe tissue damage, raising the dual problem of continence and healing and requiring the use of mattressing with a well vascularised adjacent tissue (55 cases). Group III: complicated fistulae (54) with the presence of associated lesions, often requiring multiple urological, genital and intestinal operations as well as complementary plastic techniques (31 cases): double autoplasty of the labia major (17) and adipocutaneous pedicle skin flap (14). 212 of the 261 patients (81.2%) were cured, 23 obtained partial cure (insufficient continence, amenorrhoea, vaginal sclerosis making sexual activity impossible) and there were 26 failures. Urinary diversion was the only solution in 14 patients (7.8%). The objective in surgical correction of urogenital fistulae is twofold: to obtain good quality cure (81.2%), i.e. controlled micturition and a normal, genital, conjugal and social life. overcome the limitations of palliative operations which are always poorly accepted in Africa, at the cost of repeated, staged surgery designed to simplify the lesions in the most severely damaged cases. Prevention programmes designed to eradicate urogenital fistulae, which constitutes a real public health problem in developing countries, will only be made credible by an improvement in the quality of the results obtained in the treatment of this disease.

Africa↗
PubMed1992

[Single-stage urethroplasty using a mobile pedicled cutaneous flap. Value of the extension patch and the tubular flap].

The author presents a well experimented technique for male urethral strictures. This plasty uses a mobile skin flap, taken from the scrotum or the penis, and vascularized from the dartos. The technique performed under locoregional anesthesia, offers a choice of two methods of repair: the widening patch and the substitution plasty, a tubularized graft for urethral substitution. Our technique is applicable to all types of stenoses, allowing one stage repair of all urethral strictures, whatever the cause, the site or the length of the stricture. Attention is called for on two technical points: the size of the flap which must be shorter than the urethral tissue loss; careful dissection of the pedicle, whose excellent blood supply, flexibility and mobility will provide a wide maneuverability to the graft. We have performed 237 cases using this technique and have obtained excellent results (96.7) success rate, which have proven long lasting, as follow-up exceeded 7 years for the oldest cases. Although our technique requires meticulous execution, calling for certain precautionary items that the author attempts to emphasize in this article, this widely used technique, because of its reliability and efficiency, may certainly be considered at first, particularly for the repair of difficult, infected, fistulated, and recurrent urethral strictures.

Follow-Up Studies↗
PubMed1992

[The practice of pediatric oncology in a general pediatric service in Black Africa. The experience of the hospital center of Libreville (Gabon)].

From 1984 through 1990, 41 children with malignant diseases were admitted to the department of general pediatrics of 6,700 patients. The department had 40 beds including ten for neonates. Patients often sought medical advice only late in the disease. In many cases, solutions can be found to the problems raised by the treatment of these patients in a tropical area with no specialized facilities. However, this treatment is a significant burden for both the physicians and the families and new, adapted solutions are needed.

Adolescent↗
PubMed1991

[One-stage surgical correction of complex urethral stenoses with a pedicled skin graft].

The author reports his experience and the results of a series of 104 patients suffering from urethral strictures, operated by the same operator from September 1984 to March 1990 and treated by the same surgical method: one stage urethroplasty using a pedicled skin graft. The principles which guided his technique are: complete exposure of the pathological tissue, appropriate size and cut of the graft from a healthy skin zone, careful dissection of the pedicle, elliptical anastomosis at each end and sparing of the corpora cavernosa. Eighty percent of the urethral strictures encountered in the series were complex and situated in various locations: 19 were penile, 55 were bulbar perineal, 30 were bulbar membranous. The urethral strictures were fistulated for 31 cases, multi-operated in 32 case, half of the cases had upstream repercussions from the stenosed zone, and 17 cases had an accompanying pathology. Ninety-one percent of the patients benefited from a patch graft designed to widen the stenosed zone, while a tubular graft was performed for 13 patients to reconstitute a neo-urethra. For a large number of the cases studied, postoperative follow-up was done for two years and for some cases exceeded two years. The operative results were quickly obtained. Good results observed after 3 months generally did not deteriorate thereafter, whereas bad results observed immediately after operation are not definitive since they can be reoperated by the same technique. For 82.7% of the patients, definitive cure was obtained, while 96% of the total number of patients showed considerable improvement. The intermediate results, average (13.6%) and the bad results (3.6%) both show the same inducing factors: past history of localized dilatory manipulations, infected areas but mostly defective application of management techniques. The superiority of this type of surgical technique and its reliability are stressed in the discussion. Also analysed are the following: the difficulty encountered in the management of stenoses of penile sites, the images which appear on the urethrographic controls and the cases where the choice of the tubular graft is appropriate, the problem of draining and the appropriate type and method of draining. Six years of experience in the utilisation of our technique, one-stage urethroplasty using a pedicled skin graft, leads the author to consider the technique as reliable and useful for the management of urethral strictures, especially for difficult multi-operated, infected, fistulated strictures. For these cases, our technique constitutes the best indication.

Adolescent↗
PubMed1991

[Repair of large urogenital necrosis of obstetrical origin by pedicled myocutaneous plasty of the greater lip. Technique and results].

The vesicovaginal fistulae encountered in Africa are a real plague. Their origin is obstetrical as a rule, and they occur in young women, often in primiparas. They are seldom simple as they have been operated repeatedly and involve associated lesions and a large loss of substance, so that they raise complex problems of repair. The experience with the treatment of 230 obstetrical fistulae by the same surgeon in Africa leads the author to describe a repair technique fit for complex fistulae, especially those involving an extensive loss of substance and associated lesions (rectovaginal fistula, perineal destruction). With a low approach, the procedure consists in using a filler tissue, namely a skin flap removed from a greater lip, for which the vasculature is maintained by the preservation of a thick musculous and fatty pedicle, cut from the fibers of the bulbocavernosus muscle. Once sutured around the orifice of the fistula, this graft closes it while fostering its healing. Out of the 14 patients treated with this technique, the results achieved were regarded as good for 10 (72%), including 7 after a first operation and 3 after second surgery. In 9 cases, there were associated lesions, including 5 rectovaginal fistulae and 4 cases of complete tearing of the perineum. We have had 4 failures, including 3 definitive ones, and a partial failure with the persistence of urine incontinence in station due to be destruction of the ureter. When the simpler Martius' procedure (on which ours is patterned) is no longer sufficient, the use of a pedicled skin-fat graft taken from the greater lip allows considerably restricting the indications of palliative surgery. Our technique increases the percentage of success for fistulae regarded as irreparable or after the usual repair procedures have failed.

Female↗
PubMed1990

[Double autoplasty of the labium majus in the surgical repair of vesico-recto-vaginal fistula of obstetric origin. Apropos of 17 cases].

Ten-year experience in Africa with post-delivery fistula therapy, including 39 cases of combined recto-vaginal lesions and 13 cases of laceration of perineum, prompted the author to describe a technique for surgical repair of vesico-rectovaginal fistulas. Inspired from Martius' graft of already proven efficacy in the treatment of complicated vesico-vaginal fistulas, the author used the same procedure on all complex cases of combined recto-vaginal fistulas, i.e., autoplasty of the labium majus. This operation carried out intravaginally consists in utilizing a flap of fatty tissue--either a split graft or one taken separately from each labium majus, placed in contact with the suture lines of the vesical and rectal walls. This dual autoplasty performed optimally in a single step, may however also be carried out separately whenever necessary. Over a period of 4 years (1985-1989), 17 female patients were operated on using this procedure. Treatment of both fistulas, vesico- and recto-vaginal, could be achieved in 11 cases during the same operation, and in 9 cases this involved using a single split graft. 14 women recovered, including 3 who had repeated surgery (2 bladder-derived Martius grafts and one dual autoplasty). The 3 failure cases all had repeated surgery and presented quite important lesions and tissue damage. Failure was considered final in two cases and partial in one case (residual orthostatic urinary incontinence). Dual autoplasty of the labium majus has provided cure to 14 out of 17 surgical patients in one or two operations, that is, 82% of cases, which is an excellent score considering the special difficulty of treatment encountered.

Adolescent↗
PubMed1990

[Urethroplasty using a pedicled skin graft in one-stage treatment of urethral stenosis. Review of 87 cases].

118 cases of urethral stenosis treated by the same surgeon from September, 1984, to December, 1989, have led the author to describing a one-stage technique for the surgical treatment of urethral stenosis using a widening implant or a pedicled penoscrotal tube. This technique is patterned on ORANDI's and BLANDY's procedures and utilizes a pedicled skin graft taken from a remote, therefore unaffected, site. 87 patients were treated with this procedure for urethral stenosis, often complicated by infection and fistulae, 34 after the failure of previous treatment. With a distance in time exceeding 2 years for most operated cases, the percentage of satisfied patients is of about 95%. The results were estimated according to the quality of urination, to the strength of the urine flow, to micturating and retrograde pyelography and to a fiberendoscopic checkup. In 71 cases (81.6%), the result was rated as good, immediately in 66 cases, after a second operation in 4 and after 3 operations in 1 case. The results were regarded as average in 12 cases (13.5%) and poor in 4 cases (4.6%). Cutaneous urethroplasty using a pedicled skin flap is relatively easy and represents an excellent procedure for the treatment of urethral stenosis owing to the low rate of failure and to the quality of the results obtained. The author stresses the advantages of grafting a well-vascularized skin flap, which is particularly indicated, whatever the site and extent, in cases of urethral stenosis with infection, fistulae or following several operations, the pedicled skin graft being a procedure of choice for all these aggravating factors.

Cystostomy↗
PubMed1990

[One stage surgical treatment of complex urethral strictures with a pedicled skin graft. Report of 104 cases].

The technique of one stage operations using pedicled skin grafts represent an undeniable progress in the treatment of urethral strictures. The same operator in 1984-1990 performed 104 urethroplasties by using this technique. The proposed technique, originally inspired by Orandi and Blandy was performed as surgical treatment to all of the urethral strictures encountered most often, to broaden a stenosed urethra by the use of the pedicled skin graft as a patch, for other cases, by making a tubular graft meant to replace a segment of the urethra and for 2 extreme cases to replace pratically the entire damaged urethra. The urethral strictures were of different localisations: 19 were penien, 55 were bulbar perineal, 30 were bulbar membranous. The majority of the cases were qualified as "difficult and complex urethral strictures" due to: accompanying infections and iatrogenic diseases, 31 of them were fistular stenosis, 37 were multi-operated, half of the total number of the cases suffered upstream repercussions of the stenosis, and 17 cases had an associated pathology. The author used the pedicled skin graft as a patch to broaden the stenosed urethra on 91 patients, made a tubular graft to replace a segment of the urethra for 11 patients and for 2 extreme cases, to replace practically the entire urethra. Follow-up for half of the cases operated extended up to 2 years, the longest being up to 5 years, showed that 96% of the patients were satisfied. The criteria used for judging the quality of the results were clinical, radiographic and endoscopic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[A pedicled musclefat flap of the major labia in the treatment of complex vesicovaginal fistula. Apropos of 11 cases].

Experience in fistula repair of over 190 obstetrical fistulae in Africa, all done by the same operator, have led the authors to describe a technique adequate to repair complex fistulae with a large loss of material, associated with other damages (recto-vaginal fistula, and perineal damage). This operation conducted thru the vaginal route consiste in using a replacement tissue, the pedicle musclefat flap, thick, well vascularized together with a skin graft obtained from the major labia, this is then sutured around the fistuleus gap thus permitting its closure and activating the healing process. This technique was employed on 11 patients, 8 were successfully repaired, 5 of them, after the 1st operation while for 3 of them, the fistula was repaired after the 2nd operation. For 6 cases, other damages were present: 4 recto-vaginal fistulae, 2 cases with the perinea completely damaged. We have met 3 failures, 2 are definitive, where a palliative treatment was administered (uretero-ileo-sigmoidostomie, Bricker) and 1 is considered a partial failure due to the persisting urinary incontinence from urethra damage. Our operational technique, derived from the Martius is useful for such cases wherein the Martius would be insufficient. It increases the chances of successful repair for such fistulae normally considered incurable or after failure met by the use of usual methods of fistula repair. This technique is likewise valuable because it retards the necessity of going to the extremity, which is the palliative operation.

Adolescent↗
PubMedDate not supplied

[Uretero-vaginal fistulas: diagnosis and operative tactics. Apropos of 19 personal cases].

Personal experience of the treatment of 19 uretero-vaginal fistulae, observed from september 1987 to june 1991 on 17 patients in Africa is described and analysed. Occurring after gynecological or obstetrical surgery, the main cause is hysterectomy (82.3%). Elements for diagnosis were: the appearance of a urine leak, which in most cases came rapidly, echography, and most important, intravenous urography (IVU). Surgical management in all of the cases was mainly aimed at conservation. One end-to-end anastomosis and 18 cuff reimplantations were performed, combined in 2 cases with a sub-mucus tunnel (Politano), in 14 cases combined with a tubular Boari bladder flap (wherein 1 case was bilateral), 3 combined with a bladder psoas hitch and 2 with an isolated ileal graft (ileo-uretero-cystoplasty). One case of vesicouterine fistula and 4 associated vesicovaginal fistulae benefited from a simultaneous surgical operation. In this study of 17 patients treated, except for one patient deceased 14 months following a neoplastic recurrence, the results were excellent. 16 patients were cured. Follow-up extended to more than a year and have shown the perfect conservation of the excretory ducts in all of the cases studied. The cuffed ureterovesical reimplantation combined with a tubular bladder plasty definitively seem to be a most reliable management technique for all ureter injury encountered. While allowing the preservation of the kidney located just below, it has, in particular, prevented ureter stenosis. If the use of simpler methods (psoas bladder hitch) may be sufficient for some cases, the use of more complex methods (ileo-uretero-cystoplasty) for other cases, may be indispensable.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of complicated urethral stenosis (54 case reports)].

The authors report their surgical experience of complicated stenosis of urethra in the Department of Urology of the Central Hospital of N'Djaména (Tchad) from 1984 to 1987 (July). The surgical treatment was indicated for the complicated cases of stenosis of the urethra, which were obstructed (less than a quarter of the patients who were admitted for urethra stenosis). Before 1984 the only surgical procedure was called "Chemin de fer: a blind pull-through method with a lot of complications. After 1984 the one stage urethroplasties were used in forty four cases: either with a free full thickness skin graft (DEVINE), or with a vascularized flap (BLANDY'S or ORANDI'S technique). The results are studied with a follow up of 18 months. The urethroplasties with a vascularized flap have had less failures (16%) than with a free full thickness skin graft (33%).

Adolescent↗
PubMedDate not supplied

[Mobile pedicled skin flap in one-stage repair of stenoses of the male urethra].

A simple technique is presented for the management of male urethral strictures through one-stage urethroplasty using a mobile pedicled skin flap, be it scrotal or penial skin. The distinctive feature of this technique is the use of a very versatile pedicle, with good blood supply carved out from the subcutaneous cell tissue and the dartos. Depending on the case encountered, our management technique offers a choice of two kinds of plasty: the widening patch, meant to widen the urethral canal, and the tubular graft, which consist in forming a tubular shaped graft in order to replace part or the entire urethra. Since 1984, we have performed this technique 237 times. All of the patients underwent regular check-up, and results, on the anatomical and functional aspect, were very satisfactory. Our experience in the use of this management technique has convinced us of its efficiency and reliability, particularly for infected, fistulated, recurrent and extensive urethral strictures.

Humans↗