Caione P, Capozza N, Asili L, Lais A, Matarazzo E
Division of Pediatric Urology, Department of Surgery, "Bambino Gesù" Children's Hospital, Research Institute, Rome, Italy.
J Urol. 2000 Sep;164(3 Pt 2):1061-3. doi: 10.1097/00005392-200009020-00034.
Contralateral vesicoureteral reflux occurs after successful unilateral reflux repair in a significant proportion of patients without correlation to the surgical approach. Unilateral congenital obstructive megaureter was compared to primary vesicoureteral reflux with regard to the risk of onset of contralateral reflux after unilateral ureteral reimplantation.
Unilateral congenital obstructive megaureter was diagnosed in 58 consecutive patients 2 to 10 years old (mean age 3.2). Cross-trigonal ureteroneocystostomy was performed in 57 cases and longitudinal ureteral reimplantation, according to the Politano-Leadbetter technique was done in 1. Longitudinal tapering according to Hendren was performed in 44 ureters, and the Kalicinski folding was used to repair 11 ureters. All patients underwent serial renal ultrasound, diethylenetetraminepentaacetic acid nuclear scan, excretory urogram and voiding cystourethrogram. The control group was composed of 98 age matched children with unilateral vesicoureteral reflux who underwent unilateral reimplantation with or without tapering. Fisher's exact test and Student's t test were used for statistical analysis.
Followup ranged from 1 to 5 years. All patients in both groups underwent a voiding cystourethrogram at 6 months, and renal ultrasound at 3, 6 and 12 months postoperatively. Grade 2 reflux developed in 1 study group patient after contralateral Kalicinski ureteral folding and cross-trigonal reimplantation (1.7%). In the control group new onset contralateral reflux developed in 11 cases (11.2%). The difference was statistically significant (p <0.005, Fisher's exact test p = 0. 033).
Ureteral reimplantation for unilateral congenital obstructive megaureter is not correlated with the development of contralateral reflux. The occurrence of contralateral reflux after successful unilateral reflux repair is high (11.2%), and is not correlated with age, sex and technique of reimplantation or tapering. These results support the hypothesis that the functional anatomy of the trigone is preserved in congenital obstructive megaureter but is impaired on both sides in cases of unilateral vesicoureteral reflux. The surgical management of unilateral primary vesicoureteral reflux and congenital obstructive megaureter should be differentiated based on these results.
在相当一部分患者中，单侧反流修复成功后会发生对侧膀胱输尿管反流，且与手术方式无关。将单侧先天性梗阻性巨输尿管与原发性膀胱输尿管反流在单侧输尿管再植术后对侧反流发生风险方面进行比较。
连续58例2至10岁（平均年龄3.2岁）的患者被诊断为单侧先天性梗阻性巨输尿管。57例行跨三角输尿管膀胱吻合术，1例行纵行输尿管再植术（根据Politano-Leadbetter技术）。44条输尿管根据Hendren法进行纵行缩窄，11条输尿管采用Kalicinski折叠法修复。所有患者均接受系列肾脏超声、二乙三胺五乙酸核素扫描、排泄性尿路造影和排尿性膀胱尿道造影。对照组由98例年龄匹配的单侧膀胱输尿管反流患儿组成，他们接受了单侧再植术，部分伴有输尿管缩窄。采用Fisher精确检验和Student t检验进行统计学分析。
随访时间为1至5年。两组所有患者在术后6个月均接受排尿性膀胱尿道造影，术后3、6和12个月接受肾脏超声检查。1例研究组患者在对侧Kalicinski输尿管折叠和跨三角再植术后出现2级反流（1.7%）。对照组有11例出现新发对侧反流（11.2%）。差异具有统计学意义（p<0.005，Fisher精确检验p = 0.033）。
单侧先天性梗阻性巨输尿管的输尿管再植与对侧反流的发生无关。单侧反流修复成功后对侧反流的发生率较高（11.2%），且与年龄、性别、再植或缩窄技术无关。这些结果支持以下假设：先天性梗阻性巨输尿管中三角区的功能解剖结构得以保留，但在单侧膀胱输尿管反流病例中双侧均受损。应根据这些结果区分单侧原发性膀胱输尿管反流和先天性梗阻性巨输尿管的手术治疗方法。
