Jayanthi V R, Koff S A
Section of Urology, Columbus Children's Hospital, Ohio State University, USA.
J Urol. 1999 Sep;162(3 Pt 2):1077-80. doi: 10.1016/S0022-5347(01)68073-X.
We studied the long-term outcome of transurethral puncture of ectopic ureteroceles specifically associated with duplex systems.
We retrospectively reviewed the records of patients who underwent transurethral puncture of an ectopic ureterocele. Study exclusion criteria were orthotopic, bilateral and prolapsing ureteroceles.
We identified 19 girls and 2 boys, of whom 11 presented with prenatal hydronephrosis and 10 presented with urinary tract infection. Mean age at puncture was 5 months (range 0.5 to 60). Preoperatively voiding cystourethrography revealed no reflux in 7 patients, isolated ipsilateral lower pole reflux in 8, and bilateral and/or contralateral reflux in 6. Postoperatively studies initially showed no reflux in 8 cases but in 4 of the 8 reflux recurred up to 4 years after puncture. In 10 patients (48%) reflux developed into the ureterocele and upper pole segment. Repeat puncture was required 1 to 13 months after the initial procedure in 4 patients for persistent or recurrent upper pole hydroureteronephrosis. Subsequent open surgery was required in 15 of the 21 cases (71%), including ureterocele excision with ureteral reimplantation in 14. Of the children 10 and 4 underwent open surgery for recurrent urinary tract infection and progressive reflux, respectively, while 1 underwent ureteroureterostomy for progressive upper pole reflux. No patient underwent upper pole nephrectomy. Of the remaining 6 patients 4 have low grade reflux.
Transurethral puncture of ectopic ureteroceles provides effective short-term correction of upper pole obstruction but it is not definitive therapy in the majority of cases. Most children still require open surgery. In patients without reflux after the puncture procedure new onset, recurrent or progressive reflux may later develop with extended followup. Repeat puncture may be required to ensure adequate decompression in a minority of cases, as in the 20% in our series.
我们研究了与重复肾系统特别相关的异位输尿管囊肿经尿道穿刺的长期结果。
我们回顾性分析了接受异位输尿管囊肿经尿道穿刺患者的记录。研究排除标准为原位、双侧和脱垂性输尿管囊肿。
我们确定了19名女孩和2名男孩，其中11名产前出现肾积水，10名出现尿路感染。穿刺时的平均年龄为5个月（范围0.5至60个月）。术前排尿性膀胱尿道造影显示，7例无反流，8例孤立性同侧下极反流，6例双侧和/或对侧反流。术后研究最初显示8例无反流，但其中4例在穿刺后4年内反流复发。10例患者（48%）反流发展至输尿管囊肿和上极段。4例患者在初次手术后1至13个月因持续性或复发性上极肾积水需要重复穿刺。21例患者中有15例（71%）随后需要进行开放手术，其中14例进行了输尿管囊肿切除并输尿管再植。10名儿童和4名儿童分别因复发性尿路感染和进行性反流接受了开放手术，1名儿童因进行性上极反流接受了输尿管输尿管吻合术。没有患者接受上极肾切除术。其余6例患者中有4例有低度反流。
异位输尿管囊肿经尿道穿刺可有效短期纠正上极梗阻，但在大多数情况下并非确定性治疗方法。大多数儿童仍需要开放手术。在穿刺术后无反流的患者中，随着随访时间延长，可能会出现新发、复发或进行性反流。少数情况下可能需要重复穿刺以确保充分减压，如我们系列中的20%。
