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P Y Mure

Publications and source records attributed to P Y Mure.

18 recordsLinked to original sources
PubMed2003

Long-term results of bladder neck reconstruction for incontinence in children with classical bladder exstrophy or incontinent epispadias.

OBJECTIVE: To review the long-term results of bladder neck reconstruction (BNR) in patients with classical bladder exstrophy or epispadias, and to review the concept of continence surgery in these two groups, stressing the difficulty in finding an adequate balance between urine storage (which implies high outlet resistance and low storage pressure) and complete bladder emptying (which implies low outlet resistance and a transient increase in bladder pressure); surgery cannot achieve 'continence' (which implies active mechanisms) but only 'dryness' (which implies passive mechanisms). PATIENTS AND METHODS: Eighty patients with classical bladder exstrophy (52 male, 28 female) and 25 with incontinent epispadias (17 male, 18 female) had their bladder neck reconstructed after a Young-Dees-Leadbetter procedure, subsequently modified by Mollard. The treatment is detailed and results reviewed after a mean follow-up of 11 years. All patients were treated and followed in the same institution. RESULTS: In the exstrophy group, 36 (45%) patients presented with a dry interval of > 3 h, with urethral emptying after one BNR; 52 (65%) presented with recurrent urinary tract infections, 19 (24%) with urinary stones, 21 (26%) with dilated upper urinary tracts, 13 (16%) with bladder perforations and one with an adenocarcinoma of the bladder. Thirty-eight patients (48%) required further surgery; 51% of all patients required an endoscopic procedure within 3 months after the BNR and 26% had endoscopic procedures for late (> 3 months) urine retention. In the epispadias group, 13 (52%) patients presented with a dry interval of > 3 h with urethral emptying after one BNR; 12 (48%) had recurrent urinary tract infections, five (20%) upper tract dilatation, two (8%) bladder stones, one (4%) bladder perforation and one an adenocarcinoma of the bowels after a ureterosigmoidostomy. Ten (40%) children required further surgery. CONCLUSION: We compared the present results for continence with those in other published series; most complications encountered were related to the obstructive pattern of bladder emptying and the abnormal bladder urodynamic behaviour caused by BNR. We consider that BNR is unpredictable and the roles of the other factors in urinary continence are discussed. Alternative procedures are detailed. The concept of continence surgery in exstrophy and incontinent epispadias is reviewed, stressing the importance of favouring bladder development and limiting obstructive patterns of bladder emptying that cause severe and recurrent complications.

Bladder Exstrophy↗
PubMed2002

The left Monti-Malone procedure: Preliminary results in seven cases.

BACKGROUND/PURPOSE: The management of children who have congenital intestinal dysfunction and continuous feces soiling has been improved significantly by the Malone continent caecostomy. When the appendix is not available, the Monti tube represents a good alternative to create a catheterizable conduit. The authors report here 7 cases of left continent colonic access (left Monti-Malone). METHODS: From July 1999 to January 2001 7 patients have been operated on in our unit: 6 spina bifida, 1 cloacal exstrophy. Technically, a ring of descending colon of 1.5 to 2 cm width is isolated with its meso, the Monti's tube fashioned, and implanted into the left colon according to the Malone's technique. Antegrade bowel washouts start 3 weeks after surgery with standard saline (200 to 500 mL) +/- phosphate enemas. A period of 1 to 3 months is needed to adjust to the right enema regimen to get a satisfactory result. RESULTS: The follow-up range is 18 months to 1.5 months. One patient is excluded. The duration of the enemas varies between 10 and 30 minutes, and the number of enemas varies from 1 to every 2 or 3 days. Five children are clean and perform their antegrade enemas after dinner to avoid the embarrassment of post enema leakages. CONCLUSION: Although it is a short series with a short follow-up, the first results collected show a significant shortening of the duration of the enema with excellent outcomes in terms of continence.

Adolescent↗
PubMed2001

Umbilical reconstruction in patients with exstrophy: the kangaroo pouch technique.

PURPOSE: Before the current attitude of umbilical preservation and transposition at bladder closure in patients with exstrophy the navel was systematically removed. Many patients without an umbilicus complain about this deformity. We report a simple technique of umbilical reconstruction using a rectangular skin flap fashioned as a kangaroo pouch. MATERIALS AND METHODS: Four patients 10 to 20 years old with exstrophy underwent this procedure. A small cutaneous pouch was fashioned by folding a vertical rectangular skin flap and the pouch was anchored deeply to the rectus fascia. A compressive dressing was packed into the new umbilicus and left in place for several days. RESULTS: The 4 patients have an excellent cosmetic result with adequate location, good morphology and sufficient depth at a mean followup of 8 months (range 6 to 11). CONCLUSIONS: Our technique of umbilical reconstruction is easy to perform and provides good mid-term cosmetic results. This technique is particularly adapted for patients with exstrophy who often require external genital reconstruction at the same time.

Adolescent↗
PubMed2001

[Current approach to hypospadias in children].

Hypospadias surgery has dramatically changed over the last 15 years with a new anatomical approach of the ventral penile anomalies and new techniques of repair. The description of the hypoplasia of the tissues forming the ventral aspect of the penis (ventral radius of the penis) beyond the division of the corpus spongiosum, and the concept of urethral plate are the two key-elements to select the most appropriate technique of reconstruction. These modern concepts and the various surgical techniques used are reported here with their results.

Child↗
PubMed2001

[Koff's urethral mobilization: report of 26 hypospadias presenting a distal division of the corpus spongiosum].

AIM: To evaluate the Koff urethral mobilization in 26 patients with distal division of the corpus spongiosum. MATERIAL AND METHOD: Twenty six hypospadias underwent Koff's urethral mobilization between January 1st 1999 and January 31st 2001. All cases were performed by the senior author. The mean age at surgery was 36.3 months (14 to 117 months). All cases had a distal division of the corpus spongiosum. RESULTS: The mean follow-up was 4.64 months (1-24 months): Four cases (15%) presented with a penile bleeding when the dressing was removed 4 days after the procedure. One of them went back to theatre to stop the bleeding. Five (19.2%) presented with a late meatal stenosis requiring a secondary meatotomy. One had a urethral fistula which disappeared spontaneously a few months later. All had a satisfactory cosmetic result. DISCUSSION AND CONCLUSION: These results are compared with other series published and it seems that a full penile urethral mobilization is a significant alternative procedure whose main advantage is to avoid the use of any non-urethral tissues to reconstruct the hypospadiac urethra. The selection of cases must be cautious to avoid secondary meatal stenosis which seems to be related to ischaemia of the distal hypoplastic urethra.

Child↗
PubMed2000

Transureteroureterostomy in childhood and adolescence: long-term results in 69 cases.

PURPOSE: We analyzed a series of 69 transureteroureterostomies to evaluate long-term results and specify current indications. MATERIALS AND METHODS: Between 1969 and 1998 transureteroureterostomy was performed in 32 females and 37 males with a mean age of 8.6 years. Surgery was done to avoid repeat or difficult ureteral reimplantation after multiple failed procedures in 22 cases and to create a continent ureteral conduit for intermittent catheterization in 23. Other indications included undiversion in 8 cases, ureterocystoplasty in 6, diversion in 4, the Kropp procedure in 3, massively dilated megaureter in 2 and ureteral necrosis in 1. Of the 69 patients 6 were lost to followup and 63 were followed at least 1 year (median 6). RESULTS: A total of 63 patients were regularly monitored by clinical observation and morphological investigation, including ultrasound, excretory urography and cystography. In 50 cases (79.4%) results were good with no upper urinary tract dilatation. All initially normal donor ureters remained normal. Of 51 initially dilated donor ureters 40 (78.4%) improved or returned to normal, while 20 of 27 initially dilated recipient ureters (74.1%) improved or returned to normal. Serious complications in 3 cases (4.3%) involved anastomotic leakage, ischemic stenosis of the common ureteral trunk and progressive deterioration of function in 1 kidney requiring nephrectomy 3 years postoperatively. Reoperation was successful in the former 2 cases. CONCLUSIONS: With careful attention to technique transureteroureterostomy represents a safe and reliable procedure with well-defined indications in pediatric urology.

Adolescent↗
PubMed2000

[Treatment of neurogenic urinary incontinence in children].

The current management of neurogenic urinary incontinence is exclusively urological and therefore palliative. However, urological techniques have considerably advanced over the last 20 years and now allow continence with protection of the upper urinary tract in the very great majority of cases. The authors review the various techniques proposed in achieve acceptable continence and define the indications based on published results and their personal experience.

Child↗
PubMed1999

[Drainage of pyelo-ureteral junction surgery: personal technique and review of the literature].

OBJECTIVES: To compare the various Stenting techniques used in ureteropelvic junction (UPJ) surgery and to present a personal series of 54 cases in which the Multipurpose Blue Stent (BARD, ANGIOMED) was used. PATIENTS AND METHOD: Between 1994 and 1998, 54 patients were treated for UPJ obstruction (52 underwent a Anderson-Hynes pyeloplasty and 2 a ureterocalicostomy). The Multipurpose Blue Stent insertion technique is described. The stent is removed on postoperative day 10 in the ward without cystoscopy. RESULTS: Clinical, isotopic and ultrasound improvement was obtained in 98% cases. Seven complications were reported: 4 urinary tract infections and 2 stent displacements without noticeable detrimental consequences on the outcome; 1 anastomotic leakage following a ureterocalicostomy requiring a redo operation (which was successful). The average hospital stay was 3 days. DISCUSSION: This stenting method is compared to those reported in the literature and proves to be more satisfactory in terms of hospital stay and removal. CONCLUSION: Postoperative leakage in non-stented operated UPJs is an under-reported but significant complication. Trans-anastomotic stenting has proven to be much safer than non-stenting. The Multipurpose Blue Stent reduces hospital stay and does not require a second hospitalisation to be removed.

Adolescent↗
PubMed1998

Male epispadias: experience with 45 cases.

PURPOSE: We evaluate the long-term results of surgery for isolated (without exstrophy) male epispadias. MATERIALS AND METHODS: A total of 45 male patients with isolated epispadias were treated and followed at Debrousse Hospital between 1971 and 1993, 8 in whom repairs performed elsewhere had failed and 14 had total urinary incontinence. Incontinence was treated with a modified Young-Dees reconstruction of the bladder neck and the ureters were reimplanted in all cases. Long-term followup was available in 18 cases of a Cantwell-Young-Gross, 4 Duplay, 7 full thickness skin graft, 1 bladder graft and 10 Cantwell-Ransley urethroplasties. Penile reconstruction was performed using a 2-stage procedure in 8 patients (freeing of the corpora followed by urethroplasty), and an isolated urethroplasty in 13. All other patients underwent a single stage repair combining dissection of the penis and urethroplasty. RESULTS: All patients were reassessed clinically. Of 13 incontinent patients followed for 1 to 20 years 11 acquired continence, 1 remains incontinent and 1 underwent a repeat procedure recently. Urethroplasty was immediately satisfactory in 66% of the cases, minor complications developed in 25% and serious complications (especially free graft urethroplasty) developed in 10%. Assessment of genital cosmesis is subjective but it was considered acceptable in most cases. All 29 patients with long-term followup had erections, 24 performed regular sexual intercourse, 17 had normal ejaculations and 4 fathered children. CONCLUSIONS: The principles described by Cantwell-Young and Gross, and modified by Ransley, have considerably improved penile reconstruction. Free graft and Duplay urethroplasties provided unacceptable results in our series. Our results of surgery for incontinence associated with isolated male epispadias (84%) were better than for male exstrophy (63%).

Adolescent↗
PubMed1997

[Malformations of male internal genitalia originating from the Wolffian duct].

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.

Adolescent↗
PubMed1997

Continent cystostomy (Mitrofanoff's procedure) for neurogenic bladder in children and adolescent (56 cases: long-term results).

Between 1978 and 1991 we made a continent cystostomy according to Mitrofanoff's technique in 56 patients - children or adolescents - with a neurogenic bladder. We study the complications and the long-term results (follow-up ranging from 3 to 17 years - average 10 years). One patient died from a urological complication, another one died 2 years after from a neurological complication. Two patients were lost to follow-up after 3 years. Among the other patients 36 i.e. 64.3% have had urological complications. Analysis of these complications and their treatment demonstrates that most could now be avoided. At the present time the continent cystostomy with an appendicular or ureteral conduit is the safest and most comfortable way to treat the incontinence of wheel-chair bound patients who cannot or do not wish to use transurethral catheterisation.

Adolescent↗
PubMed1997

[Malformations of Wolffian duct derived male genital organs (epididymis, vas deferens, seminal vesicules, ejaculatory ducts)].

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.

Adolescent↗
PubMed1997

Female epispadias.

PURPOSE: We assessed the incidence, anatomical features and treatment of female epispadias. MATERIALS AND METHODS: We studied 10 patients followed from 1 to 18 years. Four were operated on in 2 stages: first, cervicoplasty with original technique, and second, reconstruction of genitalia and distal urethra. Two had only a cervicoplasty. The last 4 patients were operated on in 1 stage according to Hendren's technique but with a simplified cervicoplasty. RESULTS: Eight of 10 patients are totally continent, 1 has some small nocturnal leakage, and 1 is incontinent but the interval of dryness is increasing and is longer than 1 hour. Concerning external genitalia, the result is good but not perfect. CONCLUSIONS: Female epispadias is most often complete with total incontinence. The aim of treatment is to reconstruct the anatomy in 1 stage. Treatment is easier and the results are better than in cases of female exstrophy or male incontinent epispadias.

Adolescent↗
PubMed1996

[Current treatment of hypospadias].

The aim of this work was to discuss general ideas concerning the factors which should be taken into account for the treatment of hypospadia including: anatomy, preoperative work-up, analysis of the anatomic type, patient status, search for an underlying more complex malformation. Precise indications for per and post-operative care should provide good results. Two major ideas predomination in these recommendations: operate early (at about 2 years) in a single procedure for both anatomic and psychological reasons. This latter point is particularly important. Operative technique is illustrated and described together with complications and their management.

Humans↗
PubMed1995

[Analysis of the failure of endoscopic treatment of vesico-renal reflux in children using injections of teflon and collagen and the preliminary results of injections of Macroplastic].

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.

Anuria↗
PubMedDate not supplied

[Severe bladder dysfunction in the child abuse victim. Hinman syndrome].

Severe bladder dysfunction with possible consequence on the upper urinary tract caused by psychological trauma were recently identified. Hinman in 1973 was the first to report a series of 14 patients with severe abnormal bladder and bowels behaviour with organic cause. He described the most common symptoms met in this group of patients and their management using a non surgical approach based on bladder reeducation and hypnosis. Other authors such as Allen in 1977 reported a similar experience and found severe detrusor-sphincter dyssynergia. In 1995, Ellsworth reported a relation between these abnormal bladder behaviour and a medical history of sexual aggression. We report here in a series of 7 patients with Hinman syndrome associated with aggression. Diagnosis and management by a multidisciplinary team involving paediatricians, paediatric urologists, physiotherapists, paediatric psychologists are detailed [corrected].

Adolescent↗
PubMedDate not supplied

[Proximal hypospadias].

OBJECTIVE: To evaluate the outcome of surgery in posterior hypospadias. METHOD: The technique of preservation of the urethral plate is described following three main steps: 1.-The first step is the correction of chordee which is mainly related to the two fibrous and vascular pillars sitting on each side of the urethral plate and representing the division of the atretic corpus spongiosum. Tethering of the urethral plate onto the anterior surface of the corpora cavernosa is another common cause of chordee which can be relieved by untethering the urethral plate from the ectopic meatus up to the glans cap. The urethral plate can be preserved in most cases of posterior hypospadias (35/43) and dorsal plication of the corpora cavernosa is rarely needed. 2.- The second step of this surgery is urethroplasty, which is usually achieved by using a pediculized preputial patch stitched to the urethral plate (onlay urethroplasty). 3.- Penile cover using the skin sleeve technique completes the procedure. RESULTS: Twenty one per cent fistulae, 1 meatal stenosis, no proximal stenosis are reported and discussed. CONCLUSION: Preservation of the urethral plate is possible in most posterior hypospadias and permits an onlay urethroplasty which remains to date the most reliable procedure to reconstruct the urethra in posterior hypospadias.

Humans↗