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Focus on Pediatric Urology

Epublication, May 2016;16(05). URL: http://websurg.com/doi/fc01en5
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Расположение: Список Таблица
Laparoscopic Mitrofanoff continent diversion in children
Neobladder surgery is often complex. It is readily proposed lately in a child’s life when he agrees to undergo a fairly heavy surgical operation, which will allow him to acquire a social body cleanliness. The poor vesical volume capacity may necessitate either a chemical enlargement with iterative Botox injections into the detrusor muscle, or a vesical enlargement surgery using a bowel segment.
Self-catheterization using natural orifices is often particularly uneasy in boys or in obese or handicapped patients. This mandates to leave an open vesicourethral neck, which however does not prevent potential urinary leaks. This mode of vesical voiding has an alternative, namely Mitrofanoff continent diversion using the appendix.
This procedure was described in 1980. The vesico-appendiceal junction is fashioned by means of an anatomical anti-reflux mechanism. The skin approximation onto the anterior abdominal wall can be performed either in the umbilicus, or in the inguinal region depending on different decisional criteria.
This procedure can now be envisaged laparoscopically. It is a demanding intervention, which requires advanced skills.
A El-Ghoneimi
Лекции
2 лет назад
474 просмотров
11 лайков
0 комментариев
28:15
Laparoscopic Mitrofanoff continent diversion in children
Neobladder surgery is often complex. It is readily proposed lately in a child’s life when he agrees to undergo a fairly heavy surgical operation, which will allow him to acquire a social body cleanliness. The poor vesical volume capacity may necessitate either a chemical enlargement with iterative Botox injections into the detrusor muscle, or a vesical enlargement surgery using a bowel segment.
Self-catheterization using natural orifices is often particularly uneasy in boys or in obese or handicapped patients. This mandates to leave an open vesicourethral neck, which however does not prevent potential urinary leaks. This mode of vesical voiding has an alternative, namely Mitrofanoff continent diversion using the appendix.
This procedure was described in 1980. The vesico-appendiceal junction is fashioned by means of an anatomical anti-reflux mechanism. The skin approximation onto the anterior abdominal wall can be performed either in the umbilicus, or in the inguinal region depending on different decisional criteria.
This procedure can now be envisaged laparoscopically. It is a demanding intervention, which requires advanced skills.
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
I Mushtaq
Лекции
2 лет назад
479 просмотров
31 лайков
0 комментариев
13:17
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
A El-Ghoneimi
Лекции
2 лет назад
899 просмотров
48 лайков
0 комментариев
28:15
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
Minimally invasive management of vesicoureteric reflux (VUR) and related anomalies
Operative indications in case of vesicorenal reflux in children have become increasingly rare. The true minimally invasive spirit first necessitates an endoscopic treatment, also called the STING procedure. A ureterovesical reimplantation is required in the presence of clinical or anatomical circumstances. Dr. Paul Philippe describes the operative pneumovesicoscopy developed by CK Yeung and Jeff Valla more than 15 years ago. Despite brilliant presentations, this technique has remained very confidential, probably because of the difficulties come across by the operators when performing the procedure. It is undoubtedly a very demanding technique as far as manual expertise is concerned.
The scarcity of operative indications and the difficulties met in the realization of this surgery render the acquisition of an expertise in the field difficult. However, the technique and the tricks described by Paul Philippe are absolutely remarkable and postoperative outcomes are particularly interesting. We are truly in the context which was initially described 25 years ago when laparoscopic surgery barely started to develop. It is key to reproduce exactly what was previously performed in open surgery in a laparoscopic fashion (or in the present case using pneumovesicoscopy).
P Philippe
Лекции
2 лет назад
418 просмотров
21 лайков
0 комментариев
15:24
Minimally invasive management of vesicoureteric reflux (VUR) and related anomalies
Operative indications in case of vesicorenal reflux in children have become increasingly rare. The true minimally invasive spirit first necessitates an endoscopic treatment, also called the STING procedure. A ureterovesical reimplantation is required in the presence of clinical or anatomical circumstances. Dr. Paul Philippe describes the operative pneumovesicoscopy developed by CK Yeung and Jeff Valla more than 15 years ago. Despite brilliant presentations, this technique has remained very confidential, probably because of the difficulties come across by the operators when performing the procedure. It is undoubtedly a very demanding technique as far as manual expertise is concerned.
The scarcity of operative indications and the difficulties met in the realization of this surgery render the acquisition of an expertise in the field difficult. However, the technique and the tricks described by Paul Philippe are absolutely remarkable and postoperative outcomes are particularly interesting. We are truly in the context which was initially described 25 years ago when laparoscopic surgery barely started to develop. It is key to reproduce exactly what was previously performed in open surgery in a laparoscopic fashion (or in the present case using pneumovesicoscopy).
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
F Varlet
Лекции
2 лет назад
739 просмотров
48 лайков
0 комментариев
14:58
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
Renal cancer in children and laparoscopy
Dr. François Varlet reflected on the laparoscopic management of Wilms’ tumors.
The framework of existing possibilities to perform such interventions is extremely limited and would concern 5 to 10% of patients that we currently manage. Dr. François Varlet has undertaken a prospective study on a national scale, in France, and he supervises every proposal for laparoscopic surgery to manage Wilms’ tumors. The rigorous and thorough nature of his work, the caution he takes in his work are truly outstanding.
In France, any proposal for a laparoscopic surgery to manage nephroblastoma will be discussed at national level, and the intraoperative conditions and long-term follow-up are meticulously reported, in the framework of the prospective study undertaken by François Varlet.
F Varlet
Лекции
2 лет назад
256 просмотров
14 лайков
0 комментариев
15:45
Renal cancer in children and laparoscopy
Dr. François Varlet reflected on the laparoscopic management of Wilms’ tumors.
The framework of existing possibilities to perform such interventions is extremely limited and would concern 5 to 10% of patients that we currently manage. Dr. François Varlet has undertaken a prospective study on a national scale, in France, and he supervises every proposal for laparoscopic surgery to manage Wilms’ tumors. The rigorous and thorough nature of his work, the caution he takes in his work are truly outstanding.
In France, any proposal for a laparoscopic surgery to manage nephroblastoma will be discussed at national level, and the intraoperative conditions and long-term follow-up are meticulously reported, in the framework of the prospective study undertaken by François Varlet.