Introduction. - Our aim was to evaluate electromagnetic extracorporeal shockwave lithotripsy (SWL) in treating high-density radiopaque ureteral stones on non-contrast computed tomogra-phy (NCCT).Patients and methods. - Adult patients with radiopaque stones in the ureter who underwent SWL in a high volume center between 2016 and 2017 were retrospectively included. NCCT characteristics such as mean stone density (MSD), stone size, skin to stone distance (SSD) were recorded before treatment. Treatment success was defined as complete stone clearance (SF).Results. - 108 patients were included. Global stones MSD was 1119 HU. 55% and 62% of patients were SF respectively after 1 and 2 sessions of SWL. There was no difference of success rates between the treatment of low MSD (< 1000 HU, n = 33) and high MSD (>= 1000 HU, n = 75) (P = 0.57, OR = 0.79, 95% CI [0.35-1.80]). The SF rate dropped to 31.6% for 19 patients with ureteral stenting before treatment (P = 0.02, OR = 3.34, 95% CI [1.16-9.62]). Mean stone size was 7.2 mm, SF rate for stones over 7 mm were statistically lower (P = 0.04, OR = 2.18, 95% CI [1.00-4.73]). 4 patients needed ureteral stenting in emergency after SWL (3.7%).

OBJECTIVE:To analyze the results of surgical revision for ureteral complication (ureteric stenosis or urinary leakage) after renal transplantation over a period of 10 years. MATERIALS AND METHODS:We performed a retrospective study on 1313 consecutive kidney transplantations carried out in a University Hospital Center between 2005 and 2014. The data of the patients who developed a ureteral stenosis or a urinary leakage secondary to a renal transplantation were analyzed. Combined organ transplantations (kidney-liver and kidney-pancreas), as well as pediatric transplantations were excluded. RESULTS:Seventy-six patients (5.8%) had ureteric stenosis or urinary leakage after renal transplantation. Forty-six patients (3.5%) underwent surgical revision: 27 for ureteral stenosis, 19 for urinary leakage. Early success was achieved in 26 patients (56.5%), including 14 ureteric stenosis (51.9%) and 12 urinary leakage (63.2%) (P=0.45). After a complementary endoscopic or surgical treatment, the final success rate was increased to 73.1% (34 patients): 20 ureteric stenosis (74.1%) and 14 urinary leakage (73.7%) (P=0.98). There were 2 graft losses (4.3%) and one death (2.2%). The mean glomerular filtration rate estimated by the MDRD was 44.58mL/min/1.73m2 (±14.7) before surgery and 45.37mL/min/1.73m2 (±16.5) 6 months after surgery (P=0.92). CONCLUSION:Although frequently challenging, surgical revisions for ureteral complications after renal transplantation give good results, with a low rate of graft loss and mortality. LEVEL OF EVIDENCE:4.

INTRODUCTION:Incidence of urolithiasis is increasing in industrialized countries. Amendments can be explained among others by dietary changes. More and more young patients have urolithiasis. The objective of this study was to analyze and update the epidemiology of stones in south of France about age and gender. MATERIAL AND METHODS:A retrospective single-center study from 2009 to June 2015 included all urolithiasis analyzed by infrared spectroscopy. Groups were composed according to the mineral content (oxalocalcic with whewellite and weddelite, calcium phosphate stones, uric acid stones…). RESULTS:A total of 749 stones were analyzed. The sex ratio was 1.96 all aged confused. The most common stones were oxalocalcic (51.3 %), followed mixed stones (21.2 %) and calcium phosphate stones (11.9 %). The calcium oxalate stones are mainly composed of whewellite (42 %) and calcium phosphate stones of carbapatite (18.6 %). The stones of whewellite were more frequent in men (P=0.0009), as well as uric acid stones (P=0.01) and mixed stones in women (P=0.00003), as well as calcium phosphate (P=0.0005). CONCLUSIONS:Epidemiology of stones has changed with an increased incidence in women, and nephrolithiasis patients getting older. A change in the type of stones is observed with increasing the proportion of mixed stones especially among women. Nutritional and metabolic studies are needed to find the etiology of the change in the epidemiology of urolithiasis. LEVEL OF EVIDENCE:4.

Nous présentons notre expérience initiale de NPRA avec l’utilisation d’un 4e bras aspiration/lavage utilisé par un second chirurgien sur une deuxième console. Huit NPRA ont été réalisées avec le bras aspiration/lavage développé par Intuitive Surgical (Sunnyvale, CA). Les données cliniques, opératoires et postopératoires ont été analysées et comparées à huit autres patients opérés sans ce bras. Le cas présenté était une patiente de 53 ans avec une tumeur du rein gauche de 44 mm (carcinome cellules claires) et classée RENAL 10a. Le temps d’ischémie chaude était de 14 min. Les pertes sanguines étaient de 100cc. Les suites opératoires étaient simples. Les données préopératoires ainsi que les caractéristiques anatomiques selon le score RENAL étaient similaires entre les 2 groupes (p > 0,05). Le groupe bras aspiration/lavage comparé au groupe sans avait des durées moyennes d’intervention peau à peau de 216 min contre 220 min (p = 0,9), de temps d’ischémie chaude de 14 min contre 12,6 min (p = 0,78), de pertes sanguines de 130 mL contre 226 mL (p = 0,45), de durée d’hospitalisation de 7,1 j contre 9,3 j (p = 0,51). Le taux de complication était similaire entre les 2 groupes. L’utilisation d’un 4e bras aspiration lavage n’a pas montré d’avantage significatif mais semblerait être utile en diminuant le saignement peropératoire notamment pour les tumeurs à score RENAL élevé.