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L’incidence du nombre de blesses medullaires est en constante augmentation et parmi eux 41% ont moins de 30 ans. Les possibilites de procreation sont des preoccupations essentielles chez ces jeunes patients. L’impact deletere du traumatisme medullaire sur la fonction ejaculatoire et sur les principaux parametres spermatiques sont bien documentes: le volume, la numeration et la mobilite sont perturbes. Des congelations de sperme dites « preventives » sont a envisager rapidement apres le traumatisme. La conduite a tenir chez ces patients leses medullaires qui desirent un enfant va dependre de leurs capacites ejaculatoires et du nombre de spermatozoides mobiles obtenus. Si une ejaculation est possible naturellement ou a l’aide de techniques simples (vibromassage) et que le sperme presente des caracteristiques normales une conception pourra etre tentee a domicile. Si les caracteristiques spermatiques sont mauvaises, des techniques d’AMP sont envisageables. En fonction du nombre de spermatozoides mobiles recueillis le couple beneficiera d’une insemination intra-uterine, d’une fecondation in vitro ou d’une injection intracytoplasmique.

Objective. To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis. Patient and methods. From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment. Results. Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75% (n = 16) for Politano-Leadbetter anastomosis versus 53% (n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P = .1). Conclusion. Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.

Complete, isolated trisomy of the short arm of chromosome 18 is very rare. To date, only 24 cases of trisomy 18p have been reported in the literature, making it difficult to define a potentially associated phenotype. However, the available evidence suggests that few clinical features are shared by these patients: only variable intellectual disability, variable facial dysmorphism and epilepsy are reported in a few patients. Although three inherited cases of trisomy 18p have already been reported, all were of maternal origin. We report on a patient carrying an isolated complete trisomy 18p translocated to the short arm of chromosome 14 and presenting with facial dysmorphism, mild intellectual disability and non-obstructive azoospermia. Chromosomal abnormalities are more frequent in infertile men with poor sperm quality than the general population. Both numerical and structural chromosomal aberrations have been already reported within the context of azoospermia. To our knowledge, this is the first patient with trisomy 18p to present a fertility impairment due to totally altered spermatogenesis and azoospermia. Although fertility disorders were not mentioned in the four previous reports of men with trisomy 18p, none of the latter had children. We suggest that azoospermia is a previously uncharacterized feature of trisomy 18p syndrome. We further hypothesize that two mechanisms could be responsible of the fertility impairment: a meiotic synapsis defect due to the additional 18p arm that blocks meiosis, and/or overexpression of a gene located on the 18p chromosome involved in the normal testicular development.