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Introduction: The aim of this study was to evaluate frequency and management of vascular complications in renal allograft., Patients and Methods: We performed retrospective analysis of patients who underwent renal allograft from 2001 to 2006 at our university hospital center. In order to access peri- and postoperative vascular complications, data were also obtained from donors and receivers, as well as organ procurement and renal transplant procedure., Results: One hundred and seventy-nine files were analyzed with a median follow-up of 40 months, mean age of donors was 40.4+/-11.2 years and 46.01+/-10.6 years for receivers. Seventy-two allograft patients had at least one vascular complication, with 32 cases of renal arterial stenosis, 28 cases of hematoma with surgical exploration required in seven cases, four cases of arterial thrombosis, two cases of venous thrombosis and one arterial dissection. Our series underlines that tobacco abuse in donors is a risk factor for vascular complication (p=0.043), as well as glomerular nephropathy (p=0.0185), coagulopathy (p=0.0165) and hemodialysis (p=0.02) are risk factors for receivers. Multiple arteries in renal allograft (p=0.03) and calcification on aortic patch (p=0.0274) would present a greater risk of postoperative complications. Our results demonstrate that the following parameters i.e., postoperative transfusion (p=0.011), heparin therapy (p=0.0085), immunosuppression (p=0.0478), and peri-operative aminovasopressive drugs (p=0.086) could also be implicated in vascular complication occurrence., Conclusion: A careful selection of donors remains a major factor for renal allograft quality, however arterial evaluation and coagulopathy detection in receivers must also be performed prior to transplantation procedure. A multidisciplinary approach (nephrologist, urologist, anesthesist) will optimize vascular ischemia delay and also reduce early and late vascular complications, which could have possible consequences on renal allograft and patient survival., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Purpose: In 1996 a surgical procedure for sphincter deficiency was reported in patients with neurogenic urinary incontinence. To our knowledge we report the first series that assesses this procedure since it was initially described., Materials and Methods: Seven female and 7 male patients with spinal dysraphism and neurogenic intrinsic sphincter deficiency underwent surgery between 1997 and 2005. All patients had an associated poorly compliant or small capacity bladder. Patient age ranged from 8 to 22 years (mean 14) and all patients presented with persistent urinary incontinence despite intermittent catheterization and pharmacotherapy. Evaluation was based on clinical examination, as well as preoperative and postoperative urodynamic assessments. The surgical procedure involved wrapping a pedicle strip of anterior bladder wall around the bladder neck and fixing it on the pubic symphysis. Bladder augmentation cystoplasty was also routinely performed during the same procedure., Results: Of 14 patients 13 were completely dry and 1 had stress incontinence. Followup was 2 to 8 years (mean 5). Postoperative urodynamic evaluation showed a maximum urethral pressure increase of 40%. We also observed an increase in bladder capacity of 105% and improved bladder compliance (7 ml/cm H(2)O preoperatively vs 35 ml/cm H(2)O postoperatively)., Conclusions: The bladder wall wraparound sling procedure provides excellent results for continence in association with bladder augmentation.

Renin-secreting tumour is a rare, benign entity, responsible for hypertension due to secondary hyperaldosteronism. It must be treated surgically. In the light of a review of the literature, the authors report the first published case of resection of a juxtaglomerular tumour of the kidney by laparoscopic partial nephrectomy using an ultrasound scalpel.

The authors report two clinical cases of cystic nephroma in adults observed in the department over the last 10 years. The nonspecific clinical findings and the poor contribution of imaging examinations make this rare disease difficult to diagnose. Only histological examination can confirm the diagnosis and eliminate multilocular cystic renal carcinoma or necrotic pseudocystic carcinoma. Based on a review of the literature, the authors emphasize recent pathophysiological and immunohistochemical data that could improve the management of this benign disease, in which malignant transformation is also possible.

The surgical management of stress urinary incontinence has been revolutionized with the development of minimally invasive suburethral tape techniques, which ensure a high continence rate by means of a rapid procedure with a short hospital stay. Although morbidity and adverse effects are uncommon, they must be kept in mind in order to adopt an appropriate strategy designed to prevent their development. Urinary retention is the most frequent postoperative complication of retropubic tape. The recent transobturator tape technique modifies the location of the tape with an angulation more close resembling that of fascial support tissues, thereby decreasing the theoretical risk of retention. The authors report the first case of complete urinary retention and discuss the mechanism and therapeutic strategy.