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Background: The renal transplantation is the best treatment for end-stage renal disease in children. We present the findings of an analysis of our institution's paediatric transplant outcomes comparing recipients under 15 kg, who represent this potentially higher risk group, to those above 15 kg., Methods: We retrospectively identified consecutive paediatric kidney transplants from a prospectively collected database for analysis. We included all recipients under the age of 18 years at the time of transplant between 2006 and 2018 without any exclusion criteria. The primary outcome was death-censored graft survival at 1 year, 5 years and 10 years., Results: 109 paediatric kidney transplants were performed in 100 children. Graft survival in the all population was 98%, 96% and 76% at 1 year, 5 years and 10 years, respectively. Recipient weight below 15 kg was not found to be a risk factor of graft loss. Overall, we found no individual factor to be statistically significantly associated with renal graft lost. The overall complication rate was 16% (18/109) with 12 early complications (11%) and 6 late ones (5%)., Conclusion: Kidney transplantation in children weighing < 15 kg seems safe and offers the same patient and graft survival outcomes as in other (> 15 kg) pediatric recipients with equally low complication rates., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The main objective of this multicentric retrospective pilot study was to evaluate the 1-year follow-up safety (i.e., minor [Clavien-Dindo I-II] and major [Clavien-Dindo ≥III] complications) of holmium laser enucleation of the prostate (HoLEP), GreenLight photoselective vaporization of the prostate (GL PVP), and transurethral resection of the prostate (TURP) performed after kidney transplantation (KT). The secondary objectives were to evaluate the efficacy and to assess the impact of these procedures on graft function. Materials and Methods: We retrospectively included all KT recipients who underwent a HoLEP or GL PVP or TURP for benign prostatic hyperplasia (BPH) in three French university centers. Results: From January 2013 to April 2018, 60 BPH endoscopic surgical procedures in KT recipients were performed: 17 HoLEP (HoLEP group), 9 GL PVP (GL PVP group), and 34 TURP (TURP group). Age, body mass index, preoperative serum creatinine, preoperative International Prostatic Symptom Score, preoperative Q max , preoperative prostate-specific antigen, medical history of acute urinary retention (AUR), urinary tract infection (UTI), and indwelling urethral catheter were similar in all study groups. Mean preoperative prostate volume was higher in HoLEP group. The rate of overall postoperative complications was statistically higher in the HoLEP group (11/17 [64.7%] vs 1/9 [11.1%] vs 12/34 [35.3%] in HoLEP group, GL PVP group, and TURP group, respectively, p  = 0.02), with higher rate of long-term UTI and AUR. Q max improved in all groups after operation. Delta postoperative month 12-preoperative serum creatinine was similar in the all groups. Conclusions: Although our study is underpowered, the rate of postoperative complications is higher with HoLEP procedure, in comparison with GL PVP, for the treatment of BPH after KT. One-year efficacy is similar in HoLEP, GL PVP, and TURP groups. Further prospective randomized controlled trials are needed to confirm our results.

Background: The artificial urinary sphincter (AUS) has become a commonly used therapy for severe urinary incontinence (UI) due to intrinsic sphincter deficiency (ISD)., Objective: To evaluate retrospectively the efficacy and risk factors for failure and complications of AUS implantation in women with nonneurologic UI., Design, Setting, and Participants: From May 1987 to December 2009, 215 women with ISD were treated by AUS implantation, with a mean age of 62.8 yr and a mean follow-up of 6 yr (standard deviation: 5.6 yr). Previous surgical procedures to treat incontinence had been performed in 88.8% of the patients. Urodynamic assessment was required. Patients using only 0 or 1 pad at the end of follow-up were considered continent. The patient's level of satisfaction was evaluated by a global analogue scale and clinical interview., Intervention: All women had AUS implantation., Measurements: Patients were evaluated for continence rate, risk factors for failures, and complications., Results and Limitations: At the end of follow-up, 158 patients (73.5%) were continent, and 170 (79%) were satisfied. The redo rate was 15.3% after a mean interval of 8.47 yr for the first redo procedure. Fifteen explantations (7%) were performed. The only risk factor for intraoperative complications (10.7%) was smoking (p<0.004). Six patients (2.8%) were lost to follow-up. AUS failed to treat incontinence in 51 patients (23.7%) due to defective manipulation in 27.4% of the cases. On multivariate analysis, risk factors for failure were age >70 yr (odds ratio [OR]: 2.46), a history of the Burch procedure (OR: 2.28), or pelvic radiotherapy (OR: 4.37) (p<0.05)., Conclusions: The place for this safe and long-lasting effective technique in the treatment of UI due to recurrent sphincter deficiency is confirmed. Screening for these risk factors should allow better patient selection., (Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: A simplified first-line laboratory assessment is recommended by the Stones Committee of the Association Française d'Urologie (CLAFU) right from the first episode of renal stones to detect any lithogenic risk factors. This study was designed to evaluate the feasibility of this assessment in urology, to specify the frequency of risk factors and to compare the results between first stone formers and recurrent stone formers., Material and Methods: This prospective study included patients with a first stone or recurrent stones with no previous laboratory assessment. Known cases of secondary stones were excluded. The stone or fragments had to be analysed by infrared spectrophotometry. In addition to the usual assessment, the first-line laboratory assessment was performed two to three months after the acute episode with a blood test (calcium, phosphorus, uric acid and creatinine), 24-hour urine collection (volume, calcium, uric acid, urea, creatinine, sodium) and first morning urine sample (pH, density, crystals)., Results: The results are based on 115 of the 204 patients included (69 first stones, 46 recurrent stones). The assessment was performed and interpreted easily, except for collection of stone fragments. Infrared spectrophotometry was performed in only 49 patients. Whewellite was the most frequent crystalline structure. No patients presented hyperparathyroidism or renal failure. In 69% of cases, the urinary assessment identified one or several risk factors, with insufficient diuresis (42%), hypercalciuria (29%), hypernatriuria (41%), high urinary urea (29%), and hyperuricuria (20%). 25% of patients had a single abnormality, 20% had two abnormalities, the most frequent combination being hypercalciuria-hypernatriuria, and 11% had 4 or more abnormalities. Comparison of first stone formers and recurrent stone formers did not reveal any difference in the frequency of lithogenic risk factors., Conclusion: This easy to perform assessment identified lithogenic risk factors in many cases, in both first stone formers and recurrent stone formers, that can guide the prevention of recurrent stones.

Objective: Renal transplantation is a well defined surgical procedure, but it nevertheless remains associated with a risk of medical and surgical complications. Ureteric strictures, with an incidence ranging from 2% to 7.5% according to the series, are the most frequent urological complication. The objective of this study was to determine the incidence of ureteric strictures and the existence of risk factors predisposing to the development of ureteric strictures and to evaluate their consequences on patient and graft survival, based on a single-centre retrospective series of renal transplantations., Patients and Methods: From January 1990 to December 2002, 1787 renal transplantations were performed consecutively in our centre. Graft, donor and recipient characteristics were extracted from a computerized database and validated by an independent observer. The parameters studied included donor's age and recipient's age, donor's haemodynamic status and serum creatinine at the time of harvesting, cause of death, graft weight and number of graft arteries, cold ischaemia and reperfusion times, number of HLA incompatibilities and percentage anti-HLA immunization, time to return of graft function, acute rejection, presence or absence of a double J stent, episodes of acute pyelonephritis, CMV infection and patient and graft survival according to the Kaplan-Meier method., Results: Ureteric stricture was observed in 74 patients (4.1% of cases) and a donor age greater than 65 years (p < 0.0001), the presence of more than 2 arteries on the graft (p = 0.03) and recipients with an anti-HLA immunization less than 25% (p = 0.037) were identified as independent risk factors. Furthermore, grafts complicated by ureteric stricture resumed function later (p = 0.001). The development of ureteric stricture did not have an unfavourable impact on the 10-year recipient and graft survival rates.

Objective: Ureteric strictures, with a reported incidence ranging from 2% to 7.5%, are the most frequent urological complication of renal transplantation. This article reports the results of open surgery and percutaneous or endoscopic techniques used to treat these strictures, based on a single-centre retrospective series of renal transplantations., Patients and Methods: From January 1990 to December 2002, in a series of 1787 consecutive renal transplantations performed in our centre, 74 were complicated by ureteric stricture (4.1% of cases). Strictures occurred at the ureterovesical implantation in 82.4% of cases and during the first year in 88% of cases. The mean time to management of the stricture after transplantation was 9 months (range: 6 days-120 months). Criteria of success were defined by regression or even resolution of ultrasound signs of dilatation associated with stabilization of serum creatinine obtained by the external urinary diversion. Surgical or percutaneous revisions (particularly repeated changes of double J stents) were considered to be treatment failures., Results: 44 strictures (59.5% of cases) were treated by open surgery and 30 (40.5%) were treated by a first-line endoscopic or percutaneous technique. In our hands, open surgical techniques (ureteropelvic anastomosis: 80% of success (n=5), ureterovesical reimplantation: 82% of success (n=11), ureteroureteric anastomosis: 100% of success (n=4)) gave better results than endourological techniques (endoscopic electrical incision: 61.5% of success (n=13), double J stent: 61.5% of success (n=13), balloon catheter dilatation: no success (n=4))., Conclusion: Classical open surgical revision remains the reference treatment for ureteric strictures in renal transplantation for our team.

Objective: The objective of this retrospective study was to evaluate the mortality and early and late morbidities of Bricker ileal conduit urinary diversion., Patients and Methods: Between January 1990 and December 2002, 246 Bricker ileal conduit urinary diversion was performed in our centre in 164 males (67%) and 82 females (33%) with a mean age of 64 years (range: 9 to 90 years). Bricker diversion was performed in 73.6% of cases for underlying tumour (prostate, bladder, cervical, colon cancer), and in 26.4% of cases for benign disease (neurogenic bladder radiation bladder bladder exstrophy, incrusting cystitis). Cystectomy was associated with Bricker diversion in 62.2% of cases. The mean follow-up was 24 months (range: 1 to 151 months). The following parameters were studied: mortality and early and late medical or surgical, urological and gastrointestinal complications., Results: The postoperative mortality was 6.9% (17 deaths, 16 in patients in whom Bricker diversion was performed for cancer). The early morbidity was marked by gastrointestinal complications (ileus, fistula, evisceration) in 46 cases (1.7%), 25 of which required re-operation. A medical complication was observed in 41 patients (16.7% of the series), responsible for 60% of the postoperative mortality (10 of the 17 deaths). A urinary fistula was observed in 7 patients (2.8%). The late morbidity consisted of parietal complications (incisional hernia, peristomal hernia, stricture of the stoma) in 18.3% of cases. Urological complications consisted of acute pyelonephritis (11%), ureteroileal stricture (4.9%) and urinary stones (4.9%)., Conclusion: Bricker ileal conduit urinary diversion is associated with considerable mortality, especially in cancer patients. Early complications are essentially gastrointestinal, while late complications tend to be parietal or urological.

Introduction: Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70 is considered to be associated with a higher risk than extracorporeal shock-wave lithotripsy (ESWL). However this technique is sometimes necessary for very large or complex stones in patients with several comorbidities., Study Objective: To evaluate the predictive factors of success and operative risks likely to influence the results of PCNL in a population of patients over the age of 70., Material and Method: Retrospective study of 203 patients (110 males, 97 females) over the age of 70, in whom a total of 210 PCNL were performed over a 12-year period in ten referral centres for the treatment of stones. 68.5% of cases presented a comorbidity and the median ASA score was 2. The median stone dimensions were 24 x 15 mm. There were 67 solitary pelvic stones, 7 infrapelvic ureteric stones, 31 solitary inferior caliceal stones, 40 complex stones and 13 staghorn calculi. A standard one-stage operative technique was performed in 92% of cases; the nephrostomy tract was easily performed by the urologists themselves in 71.8% of cases., Results: The overall stone-free (SF) rate was 70.8%. The patient's weight and height (p=0.03 and p=0.01), stone dimensions and their solitary nature were significant factors of success (p<0.00001 and p=0.01) with SF rates of 81.1% for pelvic stones and 90.3%for solitary inferior caliceal stones (p<0.003); the SF rate for complete staghorn calculi was only 30.8%. A history of stones (p=0.04) and diabetes (p=0.03) influenced the stone-free rate, but the other comorbidities, body mass index, and age did not influence the stone-free rate. There were two deaths (0.9% and haemostasis nephrectomy was performed in 2 ASA 3 subjects in renal failure. In the other patients, there was no difference between preoperative and postoperative serum creatinine and haemoglobin levels. The ease of nephrostomy, the rapidity of PCNL, the day of removal of the drainage nephrostomy, the mean hospital stay (median stay: 6 days), sterility of postoperative urine and at the 1-month visit were significantly correlated with the SF rate., Conclusions: PCNL in subjects over the age of 70 years is a safe and reliable technique that achieved a stone-free rate of 70.8% for all types of stones combined. The best results were obtained for solitary stones larger than 20 mm in the renal pelvis or inferior calyx. Apart from diabetes, which remains a risk factor, well controlled comorbidities do not increase the operative risk. PCNL did not affect haemodynamic parameters or renal function.