Ureteral reconstruction and bladder augmentation using intestinal allograft in a modified multivisceral transplant patient.
ABSTRACT Segments of ileum are used as conduits following ureteral resection and for bladder augmentation to achieve adequate bladder capacity. We herein report the use of a segment of transplanted ileum for this purpose in a patient with Gardner's syndrome who underwent multivisceral transplantation. To our knowledge this is the first such case report.
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ABSTRACT: Desmoid tumours are rare lesions with a local invasive potential and a risk of recurrence, considered to be benign due to the absence of metastases. They are classified as fibromatoses and may be associated with Gardner's syndrome. The authors report an unusual case, in a 33-year-old woman, of a desmoid tumour invading the right ureter with upper tract dilatation. Etiologic factors (traumatic, hormonal, auto-immune...) are discussed, together with the treatment of choice to lower the risk of recurrence.Annales d Urologie 02/1999; 33(6-7):424-7. · 0.36 Impact Factor
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ABSTRACT: To demonstrate the role of surgical trauma in desmoid tumor formation in Gardner's syndrome. Literature review indicates that desmoid tumors are exceedingly common in familial adenomatous polyposis (FAP) where the comparative risk is 852 times that of the general population. Prior abdominal surgery has been found in as many as 68% of FAP patients with abdominal desmoids. Fifty-five percent develop these lesions within 5 yr of their surgery. We describe a patient with Gardner's syndrome complicated by a desmoid tumor. This patient underwent a prophylactic colectomy at age 14, and 3 yr later developed intra-abdominal desmoid tumors unresponsive to radiation therapy, surgical excision, Sulindac, and tamoxifen therapy. The desmoids became massive and were inoperable. However, they showed an apparent complete response to a chemotherapeutic regimen of doxorubicin (90 mg/m2) and dacarbazine (900 mg/m2) in divided doses over 4 days of continuous infusion every 28 days. Because CT scans could not confirm this complete response, laparoscopy was performed. However, within a matter of only several months, desmoid tumors began developing in each of the three trocar sites, became massive and inoperable, and led to the death of this patient. These findings provide convincing evidence of the association between surgical trauma and the occurrence of desmoid tumors in patients with Gardner's syndrome.The American Journal of Gastroenterology 01/1997; 91(12):2598-601. · 7.55 Impact Factor
Article: [Augmentation enterocystoplasty].[Show abstract] [Hide abstract]
ABSTRACT: Augmentation enterocystoplasty refers to a technique that consists in removing a bowel segment in order to suture it onto the bladder. This technique is indicated in case of reduced bladder capacity and/or compliance, in case of failure of conservative treatments. The goal is to improve the patient's urination comfort, but above all to ensure long-term protection of the upper urinary tract. All bowel segments may be utilized but the ileum is the segment of choice. The selected digestive segment must be detubulized in order to better decrease its peristaltic contractions and obtain low-pressure urine storage. Bi-valving the bladder while preserving the detrusor usually performs augmentation enterocystoplasty. However, in case of very fibrous and thickened detrusor, a supra-trigonal cystectomy should be considered. The digestive segment is removed and detubulized, then it is sutured on to the bladder as a patch at the incision level. Following such surgery, over 90% of the patients report significantly improved quality of life. Nocturnal bladder competence is obtained in more than 90% of the patients, while 91 to 100% report diurnal bladder competence. Long-term complications may be observed, such as chronic infections with asymptomatic bacteruria (70% of the cases) not necessitating any treatment. Within the two first years, there is a 10% to 15% risk for stone formation following intestinal mucus development. Enterocystoplasty perforation may occur at a frequency estimated to range from 5 to 13%, which is a very serious and life-threatening complication. Similarly, a risk of enterocystoplasty cancer may be observed after five to ten years, in 1% of the cases.Annales d Urologie 01/2005; 38(6):298-310. · 0.36 Impact Factor