Mohamed Tligui

In situ extracorporeal shock wave lithotripsy for acute renal colic due to obstructing ureteral stones

The purpose of the present study was to evaluate in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of obstructing ureteral stones causing acute renal colic. In situ ESWL with an EDAP LT-02 piezo-electric lithotriptor was used in a prospective study to treat 67 patients with obstructing ureteral stones causing acute renal colic. Patients were treated without anesthesia on an out-patient basis or during a one-day hospital stay. The overall one month stone-free rate was 94% (94% for proximal stones and 95% for distal stones). The overall success rate after a single ESWL session was 81%. Treatment was well tolerated in 90% (60/67) of patients. There was one case of non-obstructive pyelonephritis and one of ureteral edema. These rates compare well with published reports for delayed treatment in patients without renal colic. Immediate ESWL for cases of acute renal colic due to obstructing ureteral stones is an effective treatment strategy that warrants wider consideration.

Retroperitoneal laparoscopic nephrectomy of native kidneys in renal transplant recipients

BACKGROUND: The purpose of this study was to compare retroperitoneal laparoscopic nephrectomy in transplant recipients and in other patients scheduled for nephrectomy. METHODS: From February 1994 to July 1996, 15 transplant recipients and 17 other patients underwent a total of 36 retroperitoneal laparoscopic nephrectomies for various indications. Operative time, morbidity, and hospital stay were compared between the two groups. RESULTS: The average operating time for the 36 procedures was 95+/-38 min (range, 35-180 min). It was shorter in transplant recipients (81+/-32 min) than in other patients (100+/-39 min, P<0.05). There was one postoperative complication in the transplant recipient group. The average length of the postoperative hospitalization was 3.7+/-1.4 days (range, 2-8 days). CONCLUSIONS: The retroperitoneal laparoscopic approach for nephrectomy is as safe and effective in renal transplant recipients as in other patients. Postoperative stay and delay to resumption of oral immunotherapy are short. This approach has become our first-line approach for native nephrectomy in transplant recipients.

Demographics and characterization of 10,282 Randall plaque-related kidney stones: a new epidemic?

AbstractRenal stone incidence has progressively increased in industrialized countries, but the implication of Randall plaque in this epidemic remains unknown. Our objectives were to determine whether the prevalence of Randall plaque-related stones increased during the past decades after having analyzed 30,149 intact stones containing mainly calcium oxalate since 1989 (cross-sectional study), and to identify determinants associated with Randall plaque-related stones in patients (case–control study).The proportion of Randall plaque-related stones was assessed over 3 time periods: 1989–1991, 1999–2001, and 2009–2011. Moreover, we analyzed clinical and biochemical parameters of 105 patients affected by calcium oxalate stones, with or without plaque.Of 30,149 calcium oxalate stones, 10,282 harbored Randall plaque residues (34.1%). The prevalence of Randall plaque-related stones increased dramatically during the past years. In young women, 17% of calcium oxalate stones were associated with Randall plaque during the 1989–1991 period, but the proportion rose to 59% 20 years later (P < 0.001). Patients with plaques experienced their first stone-related event earlier in life as compared with those without plaque (median age 26 vs 34 years, P = 0.02), had increased ionized serum calcium levels (P = 0.04), and increased serum osteocalcin (P = 0.001) but similar 25-hydroxyvitamin D levels. The logistic regression analysis showed that age (odds ratio [OR] 0.96, confidence interval [CI] 0.926–0.994, P = 0.02), weight (OR 0.97, CI 0.934–0.997, P = 0.03), and osteocalcin serum levels (OR 1.12, CI 1.020–1.234, P = 0.02) were independently associated with Randall plaque. The prevalence of the FokI f vitamin D receptor polymorphism was higher in patients with plaque (P = 0.047).In conclusion, these findings point to an epidemic of Randall plaque-associated renal stones in young patients, and suggest a possible implication of altered vitamin D response.

Laparoscopic excision of seminal vesicle cyst revealed by obstruction urinary symptoms

Abstract  Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two‐thirds are associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis. We report a case of video laparoscopic ablation of seminal vesicle cysts.

Évaluation de la pratique de la chirurgie ambulatoire en urologie : expérience d’un centre ☆

OBJECTIVE Ambulatory surgery is an alternative to traditional hospitalisation and an opportunity for savings for the healthcare system. Here, we analyze our experience in outpatient surgery in urology over a year. MATERIAL A prospective database concerning outpatient activity was established in 2009, gathering age, ASA score, type of intervention, discharge and recovery for each patient. An individual questionnaire was sent retrospectively in February 2010, to collect data about history of outpatient surgery, overall satisfaction, preference for traditional hospitalization and emergency department visits within 48 hours after surgery. RESULTS In 2009, 465 patients aged of 52±16 years (15-98) underwent urologic surgery on an outpatient basis. Median ASA score was 2 (1-3). Types of intervention were mainly endo-urology (44.5%), surgery for urinary incontinence (32.5%), and circumcision (12.3%). The postoperative hospitalization rate was 4.5%. The questionnaire response rate was 28%. Forty-six percent of the patients had already been supported in ambulatory, overall satisfaction was 3.3 out of 4 (±1.06) and 24% of patients would have preferred a traditional hospitalization. 11% of patients required emergency department care within 48 hours whatever the surgery undergone. CONCLUSION An important part of urological procedures has been done on an outpatient basis without compromising quality of care and patient satisfaction.

Malignant Epithelioid Renal Angiomyolipoma Involving the Inferior Vena Cava in a Patient with Tuberous Sclerosis

Renal angiomyolipomas (AMLs) are mesenchymal tumors that occur either sporadically or are associated with tuberous sclerosis, and are generally considered to be benign. Malignant AML is extremely rare, and most are found to be epithelioid histopathologically. The authors report the case of a patient followed for renal AML. On CT surveillance, this lesion developed features of a malignant tumor involving the renal vein and inferior vena cava. The patient was treated by nephrectomy and tumor thrombectomy with retroperitoneal lymph node dissection. Histological examination demonstrated renal AML with a malignant epithelioid contingent. The various aspects of this histological and radiological variant are discussed.

Perforations vésicales au cours d’une résection trans-uréthrale de tumeur de vessie

Resume La resection trans-urethrale de tumeur de vessie est une intervention frequente (10 711 nouveaux cas de tumeur de vessie diagnostiques en France, en 2000), non denuee de morbidite. La perforation de la paroi vesicale, qu’elle soit intra- ou extra-peritoneale, est une des complications possibles. Le diagnostic est generalement porte en per-operatoire et une cystographie sur table peut etre realisee pour objectiver le diametre de la perforation. Les perforations extra-peritoneales relevent dans la majorite des cas d’un traitement conservateur par drainage simple de la vessie. Les perforations intra-peritoneales peuvent necessiter une reparation chirurgicale. Actuellement, la Iaparoscopie tend a supplanter la chirurgie ouverte dans ces reparations. Par ailleurs, un des risques de la perforation est la dissemination et la greffe de cellules neoplasiques hors de la vessie. Il semble que les metastases liees a la perforation soient rares et apparaissent precocement imposant une surveillance rapprochee.

Retrograde Approach to a Diverticular Kidney Stone through a Vesicoureteral Cohen's Reimplantation: A Novel Surgical Technique

Cohens technique is the standard treatment of vesicoureteral reflux in children. Its disadvantage is still the classic difficulty in subsequent retrograde ureteral access, requiring the use of percutaneous techniques in the treatment of kidney stones. We describe a novel surgical technique for retrograde catheterization of an adult ureter by a flexible ureterorenoscope, thereby facilitating the treatment of a symptomatic diverticular kidney stone. We compare our technique to other methods described in the literature.

Pyonephrosis Caused by Salmonella Typhi: A Case Report.

Introduction: Salmonella is a rare cause of urinary tract infections. We report here a unique case of pyonephrosis due to Salmonella Typhi (S. Typhi) complication, a stone-related obstructive pyelonephritis. Case Report: A 47-year-old man, without any history of typhoid fever or gastrointestinal symptoms, presented with a pyonephrosis and life-threatening bacteremia following an acute obstructive right pyelonephritis caused by S. Typhi. The patient was treated by urinary drainage (ureteral stent), antibiotics, and delayed right nephrectomy. We postulated that urolithiasis could explain asymptomatic chronic urinary carriage of S. Typhi. Conclusion:S. Typhi is one possible cause of life-threatening urinary tract infection, especially in the context of urolithiasis.

Retroperitoneal Laparoscopic Nephrectomy of Native Kidneys in Renal Transplant Recipients

BACKGROUND The purpose of this study was to compare retroperitoneal laparoscopic nephrectomy in transplant recipients and in other patients scheduled for nephrectomy. METHODS From February 1994 to July 1996, 15 transplant recipients and 17 other patients underwent a total of 36 retroperitoneal laparoscopic nephrectomies for various indications. Operative time, morbidity, and hospital stay were compared between the two groups. RESULTS The average operating time for the 36 procedures was 95+/-38 min (range, 35-180 min). It was shorter in transplant recipients (81+/-32 min) than in other patients (100+/-39 min, P<0.05). There was one postoperative complication in the transplant recipient group. The average length of the postoperative hospitalization was 3.7+/-1.4 days (range, 2-8 days). CONCLUSIONS The retroperitoneal laparoscopic approach for nephrectomy is as safe and effective in renal transplant recipients as in other patients. Postoperative stay and delay to resumption of oral immunotherapy are short. This approach has become our first-line approach for native nephrectomy in transplant recipients.