Publications by authors named "Brueziere J"

Eight cases of rupture of the posterior urethra were observed in children and treated via a trans-symphyseal approach. Repair was easy in the cases seen rapidly (2 to 10 days), urethral suture was effective and the result was excellent. On the other hand, in cases seen later (6 cases), between 6 months and 5 years, marked fibrous callus had to be resected.

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A percutaneous nephrostomy (PCN) was inserted as part of the management in 17 newborns and infants with severe pelviureteric junction obstruction between 1981 and 1993. Nephrectomy was performed in eight cases and pyeloplasty in nine cases, successfully in six cases (mean follow-up: 7.7 years).

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Thirty six fistulas after hypospadias reconstruction, were operated on from 1989 to 1994. The procedure depends on the anatomical aspect of fistula. Simple fistulas of penis (33 cases) were operated by direct suture with two or three layers.

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Article Synopsis
  • Treatment of granular and subcoronal hypospadias primarily addresses psychological concerns for patients.
  • The surgical procedure involves detailed anatomical reconstruction of the urethra and foreskin through extensive dissection.
  • It is performed as a day surgery with low complication rates and does not require the use of a stent.
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An uretereo-colic anastomosis in children is performed in three occasions: 1) The trans-intestinal cutaneous ureterostomy (Bricker) has a low rate of complications concerning ureterocolic anastomosis. Nevertheless, occurrence of pyelonephrites may oblige to perform an anti-reflux procedure. 2) Implantation of ureters in the intestinal segment of an augmentation colocystoplastys in unusual; when necessary, this type of implantation is safe because colon is appropriate for an antireflux procedure.

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The renal transplantation in children has some specificities: urologic anomalies (vesico ureteral reflux, posterior urethral valves) are frequently the cause of the renal failure, and necessitate a thorough surgical preparation before transplantation (nephrectomy, reconstitution of urinary tract). The child must have a sterile, compliant and continent urinary tract on the day of the operation. In small children (< 15 kg), it is often necessary to operate through a transperitoneal incision, especially if the donor is an adult: the anastomoses will then concern the aorta and vena cava.

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Whenever the reservoir function of the bladder is impaired (neuropathic bladder and exstrophy), an enterocystoplasty constitutes a satisfactory solution in children to enlarge the bladder. The various techniques must take into account the degree of alteration of the bladder. The bowel segment must be detubularized, regardless of its origin.

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The treatment of vesical exstrophy has greatly improved over the last twenty years. The most important progresses are: closing the bladder before the 72nd hour of life; iliac osteotomy allowing fusion of the pubis when closing the bladder; lengthening of the penis by liberation of the corpora cavernosa; entero-cystoplasty when the reconstructed bladder is too small. Most surgeons practice the same timing for the different operations.

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Vesicoureteral reflux is the principal cause of pyelonephritis in children. Medical treatment is designed to prevent the development of renal parenchymal scars, as these lesions are irreversible and frequently interfere with growth of the kidney. Treatment must therefore be specific and sufficiently prolonged.

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[Enuresis].

Ann Urol (Paris)

December 1992

The word "enuresis" is the greek word for incontinence. Enuresis has to be considered as a symptom and not as a disease. We have to keep in mind that urine leaking may be due to an anatomical anomaly (epispadias, ectopic ureter, spinal coral lesion, urethral obstacle) in which case treatment of the underlying disease constitutes treatment of enuresis.

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[Ureteroceles].

Ann Urol (Paris)

December 1992

Four types of ureteroceles are described: A) ureterocele with single ureter (10%); B) ureterocele with total duplication and intra-vesical development (10%); C) ureterocele with total duplication and extra-vesical development (62%); D) ureterocele with ectopic ureter (3%). Most ureteroceles are now detected by antenatal ultrasonography, allowing early management. The treatment of types A and B is simple depending on the status of the above kidney and ureter: abstention, meatomy, ureterocelectomy with ureteral reimplantation, nephrectomy.

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The major benefit of antenatal ultrasonography is to allow early diagnosis of urinary tract malformations before postnatal infection worsens the prognosis. In the majority of cases, there is a unilateral and moderate dilatation requiring a check-up only during the second week of life; treatment subsequently depends on the etiology of the uropathy and the consequences on the kidney. Unilateral severe dilatations and bilateral, but moderate, dilatations must be managed immediately after birth in a pediatric surgical center.

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Testicular descent is a complex mechanism influenced by hormonal and anatomical factors. Whatever the age of the patient or the descent technique used for either one or both testes, there is a risk of degeneration and sterility counts. Anatomical studies and the results of sperm are important, hence the importance of establishing a precise anatomical and therapeutic classification.

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The authors report ten cases of women with previous exstrophy of the bladder or epispadias with incontinence followed up to child-bearing age. Six of the ten females had urinary diversion and four retained their bladder and were continent. Three key aspects are considered: physical appearance of the external genitalia which was satisfactory in all cases; preservation of sexual function, known in only four of the ten cases and which was reported by these patients to be satisfactory, and finally, the ability to bear children.

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Bladder exstrophy and epispadias with incontinence are associated with urinary tract and genital anomalies. The genital and sexual aspects were studied in 14 adolescent or adult males (12 exstrophies and 2 epispadias). The appearance of the penis was satisfactory in fifty percent of cases.

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The authors report twenty-two cases of obstructive anuria observed in children. Causes were diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases occurred immediately after an operation (including 8 after antireflux surgery). Emergency treatment of obstructive anuria is based on urinary diversion, ideally by percutaneous nephrostomy under ultrasonic control.

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We report a series of 13 infants with failed surgery for pyeloureteric junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either refashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ.

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The authors report twenty two cases of obstructive anuria observed in children. Causes are diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases in the immediate postoperative period (including 8 after antireflux surgery). In the emergency situation, treatment of obstructive anuria is based on urinary diversion ideally by percutaneous nephrostomy under ultrasonic control.

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Thirty-four children, ten of them coming from another Surgical Center, underwent repair for urethral fistula after hypospadias reconstructive surgery, over a period of three years (1985-1987). After the first operation, there was no recurrence in 59% (20 cases). Currently, all fistulas have been closed, except in 3 cases.

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Retrograde ejaculation of Y-V plasty of the bladder neck performed during childhood appears to be a rare complication. Based on a case treated with success, the authors stress the need for non-aggressive treatment of bladder neck disease in children (endoscopic radial incisions). The procedure proposed by J.

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We report a series of 13 infants with failed surgery for pyeloureteral junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either re-fashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ.

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Seventy-four hydronephrosis by uretero-pelvic obstruction, discovered by antenatal real-time ultrasound, have been managed on sixty-one children. Three groups, with a specific management, are distinguished. The minimal forms have been only watched over (15 cases).

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