H Fassi-Fehri

Publications (12)15.18 Total impact

• Article: [Complex renal tumors on solitary kidney: results of ex vivo nephron-sparing surgery with autotransplantation].

  M Kulisa, A Bensouda, N Vaziri, H Fassi-Fehri, L Badet, M Colombel, X Martin
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  ABSTRACT: To analyze the complications and the oncologic and functional results after ex vivo surgery and autotransplantation for the treatment of complex renal tumors. From 1996 to 2009, 11 patients, mean age 54.8 years, underwent ex vivo nephron-sparing surgery and autotransplantation for malignant complex renal tumors (centrorenal or hilar topography) on an anatomic or functional solitary kidney. Three patients (27.2 %) were treated for a metastatic disease. Mean operative time was 340 minutes (240-440) and mean ischemia time was 162 minutes (110-231). Five patients (45.4 %) needed peroperative blood transfusion. Mean hospital stay was 21.5 days (8-50). Eight patients (72.7 %) suffered complications: two urinary fistulas, two early vascular thrombosis leading to nephrectomy and permanent dialysis, two pneumopathies and four acute tubular necrosis leading to temporary dialysis. There was no death among patients in early postoperative period. Tumors TNM staging ranged from pT1 to pT3aN0. Surgical positive margins were observed in three cases (27.2 %). With a mean follow-up of 37.8 months (3-144), the mean MDRD creatinine clearance was of 45.4 ml/min/1.73 m(2) and four patients (36.4 %) were presenting a complete remission. We observed two local recurrences (18.2 %) and five metastatic evolutions (45.4 %) leading to two deaths (18.2 %). Ex vivo nephron-sparing surgery was an acceptable option in the treatment of complex renal tumors for imperative indications, when in situ surgery appeared to be technically unfeasible. Despite a significative morbidity, long-term functional results were satisfying.
  Progrès en Urologie 03/2010; 20(3):194-203. · 0.58 Impact Factor
• Article: [Bone-anchored suburethral sling complicated by pubic osteomyelitis: a case report].

  A Bensouda, M Kulisa, L Poissonnier, L Badet, M Colombel, X Martin, A Gelet, H Fassi-Fehri
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  ABSTRACT: The bulbo-urethral compression through a non-resorbable sling is a new therapeutic approach in the management of male stress urinary incontinence after prostatic surgery. Several slings are being evaluated and their way of fixing is variable according to the technique adopted. The InVancetrade mark process ensures bulbo-urethral compression by a synthetic sling anchored to the ischio-pubic rami through several titanium screws. We report the case of two patients whose operating suites of the InVancetrade mark bone-anchored male sling surgery have been marked by the appearance of a perineal suppuration associated with a pubic osteomyelitis. The healing was achieved after explantation of the material implanted (screws and sling) with bone debridement and prolonged antibiotics.
  Progrès en Urologie 03/2009; 19(2):145-8. · 0.58 Impact Factor
• Article: [Dual kidney transplant: the E. Herriot Hospital Lyon experience].

  N Rognant, R Codas Duarte, L De la Torre Abril, H Fassi Fehri, B Cuzin, M Colombel, M Dawahra, B McGregor, N Lefrançois, M Brunet, S Daoud, M Emmanuel, X Martin, L Badet
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  ABSTRACT: In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be "borderline" represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant. Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol. Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l at six months (creatinine clearance according to MDRD formula: 57.3 ml/min per 1.73 m2), 118.8 mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function. In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.
  Progrès en Urologie 12/2008; 18(10):678-84. · 0.58 Impact Factor
• Article: [AMS 800 artificial urinary sphincter implantation: can the penoscrotal approach constitute an alternative to the perineal approach?].

  H Fassi-Fehri, E M Dinia, S Genevoix, F-J Murat, L Poissonnier, L Badet, M Colombel, X Martin, A Gelet
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  ABSTRACT: To compare the short-term results of penoscrotal and perineal artificial urinary sphincter implantation. From May 2005 to February 2007, 37 artificial urinary sphincters were implanted successively, via a penoscrotal approach in 16 cases and via a perineal approach in 21 cases. Incontinence was secondary to prostate surgery (n=36) and pelvic trauma (n=1). Seventeen patients had a history of external beam radiotherapy. The times and modalities of activation of the sphincter were identical in the two groups. The mean age of the patients, the mean operating time, the mean catheterization duration, the mean hospital stay and the mean postoperative follow-up were equivalent in the two groups. Six urethral erosions (37.5%) and one scrotal erosion due to the pump (6.6%) were observed in the penoscrotal group and infection of the sphincter in two patients (9.5%) and pump migration in another two patients (9.5%), but no urethral erosions were observed in the perineal group. The success rate without revision was 56% in the penoscrotal group and 71.5% in the perineal group. The perineal approach is the reference incision, as the penoscrotal approach is associated with a high rate of erosion. The penoscrotal urethral approach can constitute an alternative when the bulbar urethra cannot be used.
  Progrès en Urologie 04/2008; 18(3):177-82. · 0.58 Impact Factor
• Article: [Kidney transplantation and lower tract obstructive uropathy treated by Botox: a case report].

  H El Fellah, Y Zakaria, H Fassi Fehri, L Badet, X Martin
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  ABSTRACT: The indications for botulinum toxin have been extended in the field of urology, especially in vesicosphincteric dysfunction with good results. The authors report the use of botulinum toxin in a kidney transplant recipient with urethral hypertonia partly responsible for end-stage chronic kidney disease. Mr E.J, 25 years old, was operated for bilateral megaureter with vesicosphincteric dysfunction during childhood. He was managed in our department with serum creatinine of 364 mol/l. Ultrasound showed bilateral ureteropelvic dilatation and residual urine of 300 ml. Urodynamic assessment demonstrated a normally active bladder with normal compliance and urethral hypertonia. An intrasphincter injection of 300 units of Botox was performed in May 2003 with a good result for 11 months. He subsequently received a second intrasphincter injection of 200 units with clinical efficacy maintained for at least six months. This patient underwent living-donor kidney transplantation in May 2005. An intrasphincter injection of 100 units of Botox was performed nine days after transplantation, then every six months. With a follow-up of 16 months, renal function is stable with negligible residual urine. The use of botulinum toxin in non neurogenic urethral hypertonia has been reported in only a few original articles. Botulinum toxin injection into the striated sphincter of the urethra decreases urethral resistance, improving obstructive symptoms and can be effective in kidney transplant recipients.
  Progrès en Urologie 03/2008; 18(2):132-5. · 0.58 Impact Factor
• Source

  Available from: eu-acme.org

  Article: Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period.

  G Pasticier, M-O Timsit, L Badet, L De La Torre Abril, M Halila, H Fassi Fehri, M Colombel, X Martin
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  ABSTRACT: To assess the incidence of complications of conservative renal surgery for renal cell carcinoma in both elective and imperative indications, and its evolution over a 15 year period. From 1988 to 2003, 127 patients underwent partial nephrectomy or tumorectomy for renal cell carcinoma in our department. Indications were imperative in 42% (n = 53) and elective in 58% (n=74) of cases. Morbidity was retrospectively assessed according to four parameters: 1- Period of surgery: A, from 1988 to 1999 and B, from 2000 to 2003. 2- Indication: elective vs. imperative. 3- experience of surgeon: senior vs. junior. 4- Nature of complications: minor or major. Comparative analysis was conducted using Chi-square and Fischer exact tests. Global incidence of complications was 30.7% (n = 39) corresponding to 18.1% minor (n = 23) and 12.6% (n = 16) major complications. Results show a moderate decrease of complication rate during Period B: 28.1% versus 32.9% during period A (p = 0.69). Complications occurred more frequently in imperative indications (49.1%) than in elective indications (17.6%) (p = 0.002), mostly regarding major complications (respectively 28.3% and 1.4%. (p < 0.001)). Overall re-intervention rate was 15.7%: 22.6% in imperative and 10.8% in elective indications (p = 0.008). Mean length of hospital stay was 14.1 days and significantly longer during period A (p = 0.003) and in imperative indications (p = 0.009). In our study, conservative renal surgery has a significant rate of complications which is extremely variable regarding to different parameters. Most discriminating factor was indication: in imperative indications, we observed a high rate of major complications (28.3%) that we consider acceptable to prevent anephria in clearly informed patients. Major complications are exceptional in elective indications. Decreased incidence of complications during the later period (B) is modest, and the role played by systematic pedicular clampage is discussed. As results published in medical literature are difficult to compare, we agree with authors who recently proposed to standardize complications data analysis, using a gravity scale, in order to provide relevant information to patients about statistical risks before surgery.
  European Urology 03/2006; 49(3):485-90. · 8.49 Impact Factor
• Article: [Surgical aspects of kidney transplantation in children (study of 148 cases)].

  A Bouhafs, H Fassi-Fehri, B Ranchin, P Cochat, X Martin
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  ABSTRACT: Kidney transplantation is the best treatment for end-stage renal disease. This procedure is by now routinely used and permits children survival and rehabilitation. We describe the surgical complications of kidney graft in our paediatric experience. From April 1987 to August 2000, 175 kidney transplantation were proceeded in the department of urology and transplantation in Edouard Herriot Hospital (Lyon). Twenty-nine kidneys (17%) were from living related donors and 146 (83%) were from cadaveric donors. We evaluated 148 kidney transplantation (132 patients) in 79 male and 53 female children. Mean age was ten years (range: seven months to 18 years). Twelve allografts were from living related donors and 136 cadaveric donors. Twelve patients died of various medical complications. One patient was lost of sight. Surgical complications were postoperative bleeding, lymphocele, urologic and digestive troubles. The rest of our patients had uneventful evolution. A general commitment is the only way to promote organ donation and enable patients with terminal renal failure to have access to renal transplantation.
  Annales d Urologie 11/2002; 36(5):301-9. · 0.36 Impact Factor
• Article: Remission of erythrocytosis and hypertension after treatment of a giant renal cyst.

  M Lezrek, H Fassi-Fehri, L Badet, J M Marechal, X Martin
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  ABSTRACT: Giant renal cysts measuring more than 15 cm in greatest diameter are uncommon and the association with erythrocytosis and hypertension is very rare. We present a case of a 22-year-old man with an incidental giant left renal cyst associated with hypertension and polycythemia that was treated by drainage and laparoscopic excision, followed by resolution of both hypertension and erythrocytosis.
  Urology 08/2002; 60(1):164. · 2.43 Impact Factor
• Article: Continent urinary cutaneous diversion in kidney transplantation: long-term results.

  M Dawahra, H Fassi-Fehri, P G Konan, J M Marechal, M DaSilva, N Lefrançois, J M Dubernard, X Martin
  Transplantation Proceedings 01/2001; 32(8):2770. · 1.00 Impact Factor
• Article: Remission of erythrocytosis and hypertension after treatment of a giant renal cyst

  M Lezrek, H Fassi-Fehri, L Badet, J.M Marechal, X Martin
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  ABSTRACT: Giant renal cysts measuring more than 15 cm in greatest diameter are uncommon and the association with erythrocytosis and hypertension is very rare. We present a case of a 22-year-old man with an incidental giant left renal cyst associated with hypertension and polycythemia that was treated by drainage and laparoscopic excision, followed by resolution of both hypertension and erythrocytosis.
  Urology.
• Source

  Available from: Nicolas Rognant

  Article: Bitransplantation rénale : expérience du protocole lyonnais de l’hôpital E.-Herriot

  N. Rognant, R. Codas Duarte, L. De la Torre Abril, H. Fassi Fehri, B. Cuzin, M. Colombel, M. Dawahra, B. McGregor, N. Lefrançois, M. Brunet, S. Daoud, M. Emmanuel, X. Martin, L. Badet
  [show abstract] [hide abstract]
  ABSTRACT: IntroductionIn the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be “borderline” represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant.Materials and methodsSince 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol.ResultsDual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l at six months (creatinine clearance according to MDRD formula: 57.3 ml/min per 1.73 m2), 118.8 mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function.ConclusionIn view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.
  Progrès en Urologie.
• Article: Aspects chirurgicaux de la greffe rénale chez l’enfant (étude de 148 cas)

  A. Bouhafs, H. Fassi-Fehri, B. Ranchin, P. Cochat, X. Martin
  [show abstract] [hide abstract]
  ABSTRACT: Objective – Kidney transplantation is the best treatment for end-stage renal disease. This procedure is by now routinely used and permits children survival and rehabilitation. We describe the surgical complications of kidney graft in our paediatric experience.Materials and Methods – From April 1987 to August 2000, 175 kidney transplantation were proceeded in the department of urology and transplantation in Édouard Herriot Hospital (Lyon). Twenty-nine kidneys (17%) were from living related donors and 146 (83%) were from cadaveric donors. We evaluated 148 kidney transplantation (132 patients) in 79 male and 53 female children. Mean age was ten years (range: seven months to 18 years). Twelve allografts were from living related donors and 136 cadaveric donors.Results – Twelve patients died of various medical complications. One patient was lost of sight. Surgical complications were postoperative bleeding, lymphocele, urologic and digestive troubles. The rest of our patients had uneventful evolution.Conclusion – A general commitment is the only way to promote organ donation and enable patients with terminal renal failure to have access to renal transplantation.
  Annales d'Urologie. 36(5):301-309.