diapo epu pediatrie
DESCRIPTION
Présentation des interventions de chirurgie pédiatrique urologique réalisées en ambulatoire sur la clinique.TRANSCRIPT
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Dr J.Prost
Dr PO. Cadi
Dr JL. Campos Fernandes
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Pathologie du prépuce
Pathologie du canal péritonéo-vaginal
Cryptorchidie testiculaire
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Pathologie du prépuce
PHIMOSIS
ADHERENCES Balano-préputiales
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Phimosis
Anneau préputial étroit ,non rétractable
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Phimosis
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Phimosis
Anneau préputial étroit ,non rétractable
La majorité des garçons à la naissance
96 %
Physiologique jusqu’à 4-5 ans
Décalottage progressif dans le bain à
partir de 8 mois
NE PAS FORCER
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Complications
Balanite
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Complications
Paraphimosis
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Paraphimosis
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Paraphimosis
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Complications
Balanite
Paraphimosis
Miction préputiales
Phimosis acquis : cicatriciel
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Indication traitement
Vers l’âge de 5 ans
Avant si complications
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Traitement
Dermocorticoïdes
- Pommade 1 application 2 fois / jour
Pendant 1 mois
- 82 % succès ( beurton 2002)
Posthectomie
Plastie prépuce
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Posthectomie
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Adhérences BP
Smegma
Phimosis associé
Libération sous Emla vers 10 ans
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Smegma
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PATHOLOGIE INGUINALE
•Garçon: Persistance du canal péritonéo
vaginal
-Hernie
-Kyste du cordon
-Hydrocèle
•Fille: Persistance du canal de Nuck
-Hernie de l’ovaire
-Hernie digestive
-kyste du canal de Nuck
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Embryologie
3 eme mois: processus vaginal en doigt
de gant
Descente testicule 7-8eme mois
8-9eme mois : regression processus
vaginal => ligament de cloquet
Oblitération CPV possible jusqu’à 1 an
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ANATOMIE CANAL INGUINAL
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HERNIE INGUINALE
C’est la persistance d’une structure
embryologique qui aurait dû
normalement disparaître
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Persistance Canal Peritonéo-
vaginal
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Clinique
Tuméfaction inguinale intermittente
descend plus ou moins loin dans le
scrotum
Origine au dessus de la ligne de
Malgaigne
Indolore
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Examen Clinique
Cordon très épaissi
Gargouille sous les doigts
Facilement réductible
Ressort à l’effort
Pas de déhiscence pariétale
Transillumination négative
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Examens complémentaires
INUTILES
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Hernie inguinale
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Kyste du cordon
Masse inguinale
Dure
Irréductible
Cordon sus jacent normal +++
En cas de doute : Echographie
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Evolution
Le CPV peut se fermer jusqu’à 9 mois
Complication
Etranglement herniaire (25%
nécrose testiculaire)
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Indications Chirurgicales
De principe si étranglement
- en urgence si irréductible
- Différée de 48 h si taxis de réduction
Chirurgie réglée
- non urgent si rentre et sort facilement
- rapidement si découverte tardive
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Cryptorchidie
Arrêt de la migration du testicule en un
point quelconque de son trajet normal,
de la région lombaire au scrotum
NE PAS CONFONDRE avec
l’ectopie qui est une anomalie de la
migration en dehors du trajet normal(
périnéal, crural, penien …)
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Migration testiculaire
physiologique
1er au 7 eme mois : descente intra-
abdominale
7 eme- 8 eme mois :Phase inguinale
8 eme – 9 eme mois : Phase scrotale
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Epidemiologie
1 à 4 % nouveaux nés à terme
80 % unilatérale , plus fréquente à
gauche
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Diagnostic
Vacuité de la bourse
Palpation chez enfant mis en confiance
et détendu
• Recherche testicule cryptorchide
( 15 % de testicule non palpé)
• Recherche hernie associée
• Appréciation développement OGE
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Complications
Torsion testiculaire
TUMEURS MALIGNES
Stérilité
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Evolution
Descente spontanée du testicule
pendant la première année
► Pas de TRT avant 18 mois
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Traitements médicaux
Indication si absence d’obstacle
anatomique à la descente testiculaire
HCG IM
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Traitement chirurgical
Testicule palpable
Orchidopexie
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Traitement chirurgical
Testicule non palpable
Coelioscopie exploratrice
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