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Cet article synthétise les interventions de nos experts lors de la table ronde de la 13e journée Urorisq en 2021 sur ce thème. Trois regards croisés permettent d'illustrer les choix et attitudes les plus appropriées dans l'assistance chirurgicale en situation d'urgence : ce sont respectivement ceux de l'assureur, de l'expert judiciaire et du représentant ordinal. Le cas d'une lésion urétérale peropératoire est le point de départ de cet article. This article summarises the interventions of our experts during the round table of the 13th Urorisq day in 2021 on this theme. Three perspectives illustrate the most appropriate choices and attitudes in surgical assistance in emergency situations: these are respectively those of the insurer, the legal expert and the ordinal representative. The case of an intraoperative ureteral lesion is the starting point of this article. [ABSTRACT FROM AUTHOR]

A new technique of electro-incision of ureteral stenoses and strictured uretero-enteric anastomoses is presented. Incision is performed with a papillotome, routinely used to achieve endoscopic retrograde sphincterotomy of the duodenal papilla. Group I: 7 ureteral stenoses were performed, on a dog model after surgical ligation of the lumbar ureter. Ten days later, through a percutaneous approach, the papillotome was placed through the stenosis, deflected, and cutting current was applied to incise the stenosis. The IVP performed one month later showed disappearance of the stenosis in 4 cases, a residual stenosis without obstacle in 2 cases and a residual stenosis with obstacle in one case. Group II: 7 strictured uretero-enteric anastomoses on 6 patients. After placement of a percutaneous nephrostomy, a wire guided papillotome was placed into the stenosis. Cutting current was then applied to cut the stenosis. A 18 F ureteral stent was subsequently placed for 8 weeks. Two patients have a patent anastomosis, 7 and 10 months after removal of the stent. One patient died from metastases of bladder tumor. The three remaining patients are still stented. An urinoma occurred in one patient the day following removal of the stent, and was surgically drained. This new technique which combines electro-incision and stenting with a large caliber stent may be proposed as an alternative to surgery or balloon dilatation for the treatment of strictured uretero-digestive anastomoses.

The authors report on 15 cases of severe dysuria following the formation of an aponeurotic support for the neck of the bladder leading to more or less complete vesicle retention. An endoscopic section through the entire thickness of the band was performed in all patients via an incision in the neck of the bladder. The band was identified in all cases. Vesical retention disappeared in 13 of 15 cases and was noticeably reduced in the other two. Perfect continence was maintained in 11 of these patients. The 4 others presented with slight problems of continence consisting in discrete leaks at night in three cases and in a few leaks when standing up or changing position in one. No vesicovaginal fistula was noted. The authors review the literature on the occasion of their work.

31 percutaneous nephrostomies (P.C.N.) were realised under a combination of real time ultrasound and fluoroscopic guidance. No failure in placement of the nephrostomy tube was noted. 13 complications were noted in 9 patients: 3 were major, consisted in 1 severe hemorrhage and 2 septicemia and 10 were minor, mainly caused by secondary displacement of the tube. Three indications of P.C.N. are related to upper urinary tract obstruction: 1) Overdistension and fever or pain associated with poor patient's condition. 2) Short-term obstructions. 3) Diagnosis of the nature or location of the obstruction when other techniques don't provide the solution, and/or evaluation of renal function. The drainage of some ureteral fistules represent the fourth indication. P.C.N. allows ureteral antegrad catheterization and its applications. Results are discussed and present or future applications of interventional uro-radiology are related.

Secondary kidney neoplasm is either silent,--and mostly unrecognized--, or its clinical and urographic features suggest a primary kidney tumor. Only computerized tomography and arteriography might differentiate these lesions before nephrectomy. They are essential investigations in case of bilateral lesions.

211 percutaneous nephrostomies (PCN) have been performed on 189 patients under combined fluoroscopic and reel time ultra-sound guidance. 4 major complications occurred with consisted in one hemorrhage and 3 septicemias. Indication of the PCN was diagnostic in 35 cases and therapeutic in 176 cases. Decompression of pyelo-caliceal system (89 cases) among with 72 in emergency, drying of an urinary fistula (8 cases), balloon dilatation of benign ureteral stenoses (18 cases) and treatment of 60 renal stones (3 dissolutions and 57 extractions). Results showed the drying of the fistula in all cases, the long term success of the balloon dilatation in 50% cases and 80% success rate of stone extraction.

The Nesbit procedure is proposed in the treatment of the penile curvature. Our technique is a longitudinal incision followed by a transversal suture. From 1981 to 1986, 25 patients were operated: 19 fair results, 4 good, 2 unsatisfying. The shortening of the phallus is the major pitfall of the technique.