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To provide an adequate lifelong urological care in the complex period of adolescence, a transition consultation conducted by a paediatric surgeon and an urologist was developed in our institution. As a real rite of passage, it allows the follow-up and the adapted care of urological conditions, sometimes complex, and permits the transition between childhood and the world of grown-ups. We reported our experience at the Children Hospital of our institution (paediatric surgery and urology departments). During a 6 months period (January-July 2015), forty-five young adults with a mean age of 17.8±3.6 years were seen in transition consultation. Eight patients had neurogenic voiding disorders (4 spina bifida, 1 multiple sclerosis, 1 mitochondrial encephalopathy, 1 metachromic leucodystrophy, 1 paraplegia), 9 patients had idiopathic voiding disorders, 1 patient had a non obstructive malformative uropathy; and 30 patients had surgery during infancy and childhood: hypospadias in 17 young men and malformative uropathy in 13 patients. This consultation occurred within 4.6±4.5 years after the last consultation with paediatric surgeon. For 6 patients, the transition consultation was the first for the urological problem. After this consultation, 8 patients stayed in paediatric surgery and 37 patients were referred to adult urologist. Among those 8 patients: 2 patients had cognitive and psychiatric disorders; 4 patients refused to be transferred to adult unit; 2 patients wanted to come back at transition consultation. Among the 37 patients transferred in adult urological care: 6 patients had urological surgery, and one patient was referred to a sexology consultation. The remaining 30 patients have initiated long-term monitoring. All reconvened patients came back at the follow-up visit (at least 12 months follow-up). A 16-year-old patient (spina bifida with polymalformative syndrome) developed a depressive syndrome at the end of the consultation, in the motive of an awareness of the definitive nature of his handicap and the need of medical follow-up throughout his life. Transition consultation makes easier the passage from paediatric care to adult urological care. It allows a smooth change of interlocutors, facilitates subsequent care and improves compliance to medical follow-up. It requires a good collaboration between paediatric and adult care units. Transition responds to an increasing request of adolescents, families, and medical teams, since care rupture during adolescence can have functional and psychological consequences. Level of proof 4.

Urosepsis in adults comprises approximately 25% of all sepsis cases and in most cases is due to complicated urinary tract infections (UTIs). In this paper we review the optimal management of urosepsis from the urological point of view. Urosepsis is often due to obstructed uropathy of the upper or lower urinary tract. The treatment of urosepsis comprises four major aspects: 1. Early goal-directed therapy; 2. Optimal pharmacodynamic exposure to antimicrobials both in blood and in the urinary tract; 3. Control of complicating factors in the urinary tract; 4. Specific sepsis therapy. Early tissue oxygenation, appropriate initial antibiotic therapy and rapid identification and control of the septic focus in the urinary tract are critical steps in the successful management of a patient with severe urosepsis. To achieve this goal an optimal interdisciplinary approach encompassing the emergency unit, urological specialties and intensive-care medicine is necessary.

INTRODUCTION Inguinal hernia in men is common but uretero-inguinal hernia is very rare. PRESENTATION OF CASE A 85-year-old obese man presented with chronic obstructive uropathy with previous renal ultrasound showing bilateral enlarged kidneys and hydronephrosis. The medical history revealed a 3-year history of a noticeable bilateral partial reducible inguinoscrotal herniae associated with urinary symptoms. Progress CT scan showed very large inguinal herniae, which were predominantly fat-containing with the ureters herniated, and both kidneys were displaced inferiorly. DISCUSSION Uretero-inguinal hernia in patients with native kidneys is rare, but cases of renal failure secondary to uretero-inguinal hernia have also been reported previously in the literature with two anatomical variations have been reported – paraperitoneal and extraperitoneal types. Endourological and surgical procedures are rarely straight-forward because of tortuosity of the herniated ureter. CONCLUSION Although uretero-inguinal hernia is rare, it can be the cause of chronic renal impairment.

Purpose Renal transplantation (RT) from living-related donor (LRD) has important advantages regarding the improvement in transplant graft survival and the decreasing need of dialysis. Material and methods Of the last 166 renal transplants performed in our institution between 1994 and 2005, 44 (26.5%) were from LRD. We reviewed these 44 LRD, comparing the long-term results with cadaveric donors CD during the same period (50.5±33 months). All transplants were first grade living donors (17 fathers and 27 mothers). Mean age was 39.93±6.49 years old (26-50). Cold ischemic time was 1.8±0.52 hours. Primary renal disease was renal dysplasia (26.4%), nephropathy (13.2%), uropathy (30.9%), nephronoptisis (8.7%), glomerulopathy (6.6%) and others (11%). Mean age at renal transplant was 11.22 years (range 3.1-21.3). Twenty-two patients (50%) underwent transplantation before dialysis and 6 patients needed urinary tract reconstruction before surgery, and 22.7% were retransplants (second one in 8 patients, third in 1 case and fourth in 1 patient). Results Graft survival rates LD compared to CD was 97.6% vs 89% at one year, 89.4%-78% at 5 years and 80%-39% after 10 years. There were 4 graft loss due to rejection. Two patients died after 10 and 12 months of dialysis because of graft failure. Mean GFR was 84.5 ml/min/1.73 m (39.4-130 ml/min/m). Conclusions Renal transplantation from living-related-donors has a better long-term graft survival for first graft or even in retransplantion. RT from LRD must be the first choice of treatment for all patients with end stage renal disease.

Ascending uretero-pyelography has been carried out over a period of 13 years in 97 consecutive patients with undiagnosed renal failure. Sixty-nine were in a non-obstructive uropathy group while 26 had ureteric obstructions. There were two failures. Over 60% of examinations were performed under local anaesthesia, each examination taking an average of 20 min. There has been no mortality and two anaesthetic complications have been the only significant morbidity. Ureteric injury, urinary infection and renal function have all been investigated and recorded. Five per cent of patients developed urinary infection following AUP but without any major consequences. No significant ureteric injury occurred and no late sequelae were noted. Neither any reaction to contrast medium nor any further deterioration in renal function was observed; AUP was diagnostic in 46% of patients. In the remainder it ruled out obstructive uropathy and gave useful information about the kidneys, ureters and bladder. In experienced hands and with proper facilities AUP is safe and can be helpful in the diagnosis and management of patients in renal failure.

HE PAST DECADE has seen increased effort directed toward repair of the urinary tracts of children with severe obstructed uropathy. 1-7 Such repair has proved successful in most instances despite the complexity of these problems and the difficulty of the surgery. Many youngsters however, have had some type of urinary diversion in the past before current techniques were developed, or more recently in the belief that their renal function was too much reduced to prevent any approach except permanent diversion. Diversion methods have included ileal conduit, cutaneous vesicostomy, cutaneous ureterostomy, suprapubic tube cystostomy, and tube nephrostomy. Long-term follow-up of such children has been dismal in some cases. Although there may be initial improvement, all too often it is followed by gradual deterioration from continuing low-grade infection, s Improved results in various pediatric obstructive uropathies have prompted us to attempt reconstruction of certain children who had been previously diverted. This paper will describe an experience with undiversion of the urinary tract in ten children with the following types of drainage: ileal loop in three (for 6, 6, and 5 yr); suprapubic cystostomy in three (for 6, 3, and 2 yr); nephrostomy in two (for 10 and 9 yr); ureterostomy in one (for 9 yr); and both nephrostomy and cystostomy in one (for 16 yr).