Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.

/pdf/morphological-and-clinical-aspects-of-the-occurrence-of-d2uiik0r4n.pdf

Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries.

Continence Outcomes in Patients Undergoing Robotic Assisted Laparoscopic Mitrofanoff Appendicovesicostomy

The aim of the study was to determine the distribution patterns of multiple renal arteries, evaluate how they are affected by gender and bilateral asymmetry and proceed on a systematic review. Two hundred and six kidneys from 103 Greek cadavers (53 males and 50 females) were investigated. The number and pattern of multiple renal arteries were determined according to side, gender and level of origin. The distances between the main renal and first multiple renal arteries were also measured. Multiple renal arteries were present in 11.2% of the kidneys. No statistically significant difference was found between side and gender (p>0.05). The incidence of multiple renal arteries was 87% unilaterally and 13% bilaterally. As regards the multiple renal arteries, a single artery was detected in 83%, two in 13% and three in 4.3%. In 30.4% (7/23) of the kidneys, there was a short common trunk (<1.5 cm), early dividing into the main renal artery and a thinner artery. Multiple renal arteries on the left side seemed to emerge lower than the right ones and displayed a greater variability at their origin. In the systematic review, we detected the patterns of multiple renal arteries which were classified according to population, gender, side and specimen (cadaveric, radiological or transplant). The awareness of morphology and topography of the multiple renal arteries is important in order to achieve a safe pre and intraoperative management of the renal vascular supply.

A morphometric study of multiple renal arteries in Greek population and a systematic review.

Comparison of complications of robot-assisted laparoscopic and open appendicovesicostomy in children

Objective

To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches.




Patients and Methods

Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty.
Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4).
The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire.




Results

All surgeries were successfully completed with no conversions. Operating time was always <5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months.
Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure.
Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient.
Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery.




Conclusions

While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.

Laparoscopic and robot-assisted continent urinary diversions (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 15 adult patients: The Saint Augustin technique

Introduction We compared short- and long-term outcomes of renal transplants with single versus multiple arteries. Patients and methods We retrospectively analyzed data from kidney transplants from 208 living donors performed between 1994 and 2010. Renal grafts were divided into two groups: single renal artery ( n = 164) versus multiple renal arteries ( n = 44). The groups were compared regarding early and late vascular and urological complications. Patient and graft survivals were compared using Kaplan-Meier survivorship curves with comparisons using the log-rank test. Results Both groups were comparable regarding acute rejection episodes, posttransplant hypertension, postsurgery renal artery stenosis, and urologic complications. Only hemorrhagic complications and renal artery thrombosis were significantly higher in the multiple renal arteries group ( P = .027 and .03, respectively). Warm ischemia time was significantly longer in the multiple renal arteries group without any influence on the incidence of acute tubular necrosis ( P = .2). Mean creatinine clearance at 1 year was 65 versus 50 mL/min/1.73 m 2 ( P = .5) and at 5 years, 60 versus 55 mL/min/1.73 m 2 ( P = .1) for the single versus multiple renal arteries groups, respectively. Return to hemodialysis was necessary for 18.8% of the single and 16.1% of the multiple renal arteries group. Conclusion The use of an allograft with multiple renal arteries is a safe, successful surgical procedure, that does not influence patient or graft survivals or increase surgical complication rates provided the surgical team is evolved with technical skill.

Does Kidney Transplantation with Multiple Arteries Affect Graft Survival

Resume Objectifs Evaluer les resultats du traitement chirurgical de la varicocele, en terme d’amelioration de la qualite du sperme et de la procreation, ainsi que l’apport de ce traitement chez les couples candidats a la procreation medicalement assistee (PMA). Materiels et methodes Notre etude etait retrospective, portant sur 164 hommes infertiles, ayant une varicocele associee a des anomalies du spermogramme. Nous avons reparti nos patients en quatre groupes, en fonction du nombre total de spermatozoides mobiles (TMC). Groupe 1 comprenait 21 patients azoospermiques, groupe 2 (TMC  6 ) comprenait 62 patients, groupe 3 (TMC entre 1,5 et 5 × 10 6 ) comprenait 22 patients et groupe 4 (TMC > 5 × 10 6 ) comprenait 59 patients. Tous les patients ont eu un traitement chirurgical ou par embolisation de leur varicocele. Resultats Apres traitement, nous avons note une augmentation significative des moyennes des concentrations et des pourcentages des spermatozoides motiles, passant respectivement de 24,8 a 29,2 × 10 6  spermatozoides par millilitre et de 14,4 a 23,2 % et la survenue d’une grossesse spontanee ou hors AMP chez 59 couples (35,9 %). Concernant les couples qui n’ont pas eu de grossesses, 51 (soit 48,5 %) ont pu avoir une augmentation du TMC leur permettant de changer la technique de la PMA prevue en preoperatoire par une autre plus simple. Conclusion Le traitement chirurgical de la varicocele a permis d’ameliorer significativement les parametres spermatiques chez les patients infertiles et d’augmenter les chances de procreer chez le couple. Il a permis aussi aux couples qui n’ont pas eu de grossesses, d’acceder a une technique de PMA plus simple que celle prevue en preoperatoire.

Le traitement chirurgical de la varicocèle améliore la fertilité et aide à la procréation médicalement assistée

Resume But Analyser les parametres urodynamiques de la derivation urinaire de Mitrofanoff et etudier ses mecanismes de continence. Materiel et methodes Onze patients continents ont eu une evaluation urodynamique de leurs derivations urinaires de Mitrofanoff a travers la stomie. L’âge moyen des patients au moment de l’intervention etait de 29 ans. L’appendice utilise comme conduit (100 %), a ete abouche a la peau au niveau de la fosse iliaque droite. Dix patients ont eu une ileocystoplastie. Le bilan urodynamique a ete realise apres un recul moyen de sept ans (cinq a 12 ans). Resultats Les pressions du reservoir apres remplissage n’ont pas depasse 20 cm H2O dans neuf cas. Des contractions non inhibees ont ete enregistrees dans deux cas sur une vessie agrandie avec des pressions n’excedant pas 30 cm H2O. Les pressions de l’appendice lors du remplissage ont ete toujours superieures a celles du reservoir vesical. La moyenne des pressions mesurees en fin de remplissage a ete de 75 cm H2O (45 a 90 cm H2O). Apres la manœuvre de Valsalva, ces pressions ont ete entre 80 et 150 cm H2O avec bonne transmission. La moyenne des pressions de cloture du conduit a ete de 70 cm H2O (40 a 90 cm H2O). La longueur fonctionnelle moyenne du conduit a ete de 5 cm (2,6 a 7,2 cm). Conclusion Le montage de Mitrofanoff se caracterisait principalement par l’importance des pressions intraluminales du conduit de continence. La basse pression du reservoir vesical est imperative pour maintenir le montage parfaitement continent.

Dérivation urinaire de Mitrofanoff. Mécanismes physiques et explication urodynamique de la continence

But: Evaluer le retentissement psychologique et le degre d'adaptation dans la vie courante des patients qui ont eu une derivation urinaire externe continente de type Mitrofanoff. Patients et Methode: Cinquante sept patients ont ete interroges a propos de leurs derivations urinaires continentes de type MITROFANOFF. Cette etude a ete realisee a l'aide d'un questionnaire traduit en langue arabe parle. Resultats: L'âge moyen etait de 29 ans (10 a 72 ans). L'indication de la derivation etait une etiologie neurologique dans 91% des cas. La continence a ete obtenue dans tous les cas dont 3 apres revision chirurgicale. L'auto sondage a ete juge facile et non contraignant dans 49 cas (86%). Les contraintes des activites quotidiennes et de loisir imputees a la derivation ont ete occasionnelles et moderees. Elles ont ete estimees entre 3,5 et 17,5%. Seize patients (94%) ont repris leurs activites professionnelles et quinze autres (79%) ont repris leur scolarite avec succes. Dix-neuf patients (83%) sexuellement actifs en pre operatoire, ont dit etre satisfaits de leur sexualite apres l'intervention. Enfin, cette intervention a ete tres appreciee par les patients dans 96,5% des cas pour des raisons hygieniques et psychologiques. Conclusion: La derivation de type MITROFANOFF permet une reinsertion socioprofessionnelle et familiale satisfaisante a la condition d'une bonne adaptation a la prise en charge de la derivation.

Dérivation urinaire continente de type Mitrofanoff : point de vue de 57 patients

https://www.ajol.info/index.php/aju/article/download/98510/87779

Le ganglioneurome rétropéritonéal: À propos de 5 cas et revue de la littérature

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