Thomas Blanc

Publications (3)15.11 Total impact

• Article: Retroperitoneal Laparoscopic Pyeloplasty in Children: Long-Term Outcome and Critical Analysis of 10-Year Experience in a Teaching Center.

  Thomas Blanc, Cecile Muller, Hendy Abdoul, Stoyen Peev, Annabel Paye-Jaouen, Matthieu Peycelon, Elisabeth Carricaburu, Alaa El-Ghoneimi
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  ABSTRACT: BACKGROUND: Laparoscopic pyeloplasty in children remains controversial and is not included in most pediatric urology centers because of technical difficulties and lack of long-term results. OBJECTIVE: To critically analyze our 10-yr experience with the retroperitoneal approach (RA), with a particular interest on the impact of the learning curve in a teaching center. DESIGN, SETTING, AND PARTICIPANTS: Patients who underwent pyeloplasty between 1999 and 2010 at our institution were reviewed (n=390). The diagnosis of ureteropelvic junction obstruction was confirmed by ultrasound and technetium Tc 99m mercaptoacetyltriglycine-3 renal scan or magnetic resonance imaging; the same criteria were used to evaluate the outcome. The lateral RA was selected in children >1 yr of age without abnormal migration or fusion of the kidney (n=104). SURGICAL PROCEDURE: Dismembered pyeloplasty and anastomosis were performed using running monofilament 5-0 or 6-0 absorbable suture. All were drained by double-J stent except 20 cases drained by external transanastomotic stent. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed intra- and postoperative morbidity and analyzed the teaching of technique and learning curve. Data are expressed as medians and interquartile range (25th, 75th percentiles) for quantitative variables. RESULTS AND LIMITATIONS: Median age was 6.2 yr (2.2-10.3). Thirty-three patients had crossing vessels. Median operative time was 185min (160-235). Median hospital stay was 2 d (1-2). Redo pyeloplasty was needed in only two children (2%). Median follow-up was 2.1 yr (1.4-4.1). Operative time was <3h after 35 cases. After 30 cases performed by the same surgeon, standardization of the technique was feasible, which helped in the teaching process because 50% of the final 30 cases were done by trainees. CONCLUSIONS: Retroperitoneal dismembered laparoscopic pyeloplasty is a safe, reliable, and efficient procedure with an excellent outcome in selected children according to their indications and age, and the experience of the surgical team. Even if the transmission to trainees is successful, it is still a long learning process and remains a challenging task for a teaching center.
  European urology 08/2012; · 7.67 Impact Factor
• Article: Testicular function and physical outcome in young adult males diagnosed with idiopathic 46 XY disorders of sex development during childhood.

  Thomas Blanc, Ahmed Ayedi, Alaa El-Ghoneimi, Hendy Abdoul, Yves Aigrain, Françoise Paris, Charles Sultan, Jean-Claude Carel, Juliane Léger
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  ABSTRACT: There are few studies of outcome in male patients with undefined 46 XY disorder of sex development (DSD). We aimed to assess testicular function and clinical characteristics after puberty in men with idiopathic 46 XY DSD. Design We conducted a University Hospital-based observational follow-up study. Nineteen patients with severe hypospadias associated with other signs of defective virilization, such as microphallus, cryptorchidism, and/or bifid scrotum, who were initially managed during childhood between 1988 and 1994, were evaluated at a median age of 17.6 (16.3; 17.8) years. Outcome measures included clinical findings and serum testosterone, FSH, LH, and inhibin B concentrations. Testicular function was normal in only five (26%) patients. Impaired testicular function was observed in 14 (74%) patients and was partial (n=6; 32%) or total (n=8; 42%), requiring testosterone treatment for the initial (n=2) or secondary (n=6) induction of puberty. Undescended testis (unilateral n=3, bilateral n=2) was found and surgically managed only in the 14 patients with testicular impairment. Testosterone treatment in early childhood greatly increased penis length in all patients, but persistent microphallus following surgical treatment was observed at the end of puberty in most patients, with no difference between patients with and without testicular dysfunction (penis length of 68 (60; 75) vs 65 (60; 65) mm; P=0.42). Half the patients presented an adult height more than 5 cm below their target height. Men diagnosed with idiopathic 46 XY DSD during childhood are at high risk of testicular insufficiency and persistent micropenis, and this should be taken into account during the follow-up.
  European Journal of Endocrinology 09/2011; 165(6):907-15. · 3.42 Impact Factor
• Article: Preliminary experience with external ureteropelvic stent: alternative to double-j stent in laparoscopic pyeloplasty in children.

  Tamer Helmy, Thomas Blanc, Annabel Paye-Jaouen, Alaa El-Ghoneimi
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  ABSTRACT: We assessed whether an external ureteropelvic stent was a feasible and safe alternative to Double-J® stent after laparoscopic pyeloplasty in children, thus avoiding a second general anesthesia. Our study included 22 concurrent age matched children who underwent retroperitoneal laparoscopic pyeloplasty between 2000 and 2008. In group 1 an external ureteropelvic stent was inserted through the renal pelvis, then clamped on postoperative day 2. In group 2 a Double-J stent was antegradely inserted. The ureteropelvic stent was removed at the outpatient clinic on day 10, while the Double-J stent was removed under general anesthesia at 1 month. We retrospectively compared operative time, hospital stay, intraoperative and postoperative complications, and followup. Mean±SD age at surgery was 31±9 months in group 1 and 37±12 months in group 2. Mean±SD operative time was slightly shorter in group 1 (190±40 minutes) than in group 2 (205±23 minutes). No intraoperative complications were encountered during placement of stent. Mean±SD hospital stay was 2.18±1.20 days in group 1 and 2.45±0.54 days in group 2. No postoperative complications were reported in group 1. The Double-J stent was noted in the posterior urethra in 1 patient in group 2, requiring cystoscopic repositioning. No patient had urinary tract infection. Median followup was 34 months (range 22 to 56) in group 1 and 35 months (16 to 72) in group 2. The feasibility of external ureteropelvic stenting after laparoscopic pyeloplasty will pave the way to minimizing the use of Double-J stenting and eliminating a second general anesthesia for catheter removal.
  The Journal of urology 03/2011; 185(3):1065-9. · 4.02 Impact Factor