Hemal A K, Ansari M S, Doddamani D, Gupta N P
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Urology. 2003 Apr;61(4):703-7; discussion 707. doi: 10.1016/s0090-4295(02)02590-6.
Primary obstructive megaureter is an uncommon presentation in adult patients. Although not reported frequently in published studies, the anomaly exists and warrants aggressive surgical management in contrast to its presentation in children.
This study was composed of 55 patients (47 with unilateral and 8 with bilateral megaureters) with adult primary obstructive megaureter who were treated from January 1989 to December 2001. Their clinical presentation, renal function, radiologic data, treatment, complications, and follow-up were studied.
Of the 55 patients, 36 were male and 19 were female (age range 13 to 52 years). All patients were symptomatic except two. Forty-four patients (50 renoureteral units) required ureteral reimplantation, with tailoring in 33. Five patients were treated with endoscopic techniques (ureteral meatotomy in 3 and ureteroscopic retrieval of ureteral calculi in 2). Four patients required nephroureterectomy for nonfunctioning kidneys. Associated renal calculi were managed by extracorporeal shock wave lithotripsy and pyelolithotomy and ureteral calculi by endoscopic methods or calculi removed at the time of ureteroneocystostomy. All but 4 patients showed improvement in hydroureter and hydronephrosis and developed no complications during the follow-up period of 1 to 12 years (mean 7). Five patients with bilateral megaureters had uremia. Only one improved after surgery with adequate drainage and 2 patients died despite reimplantation.
Most adult patients with megaureter are symptomatic. Complications such as stone formation and deranged function of the affected kidney are common and almost all require surgical intervention. Surgery in those with bilateral megaureters with advanced renal failure is mostly unrewarding.
原发性梗阻性巨输尿管在成年患者中并不常见。尽管在已发表的研究中报道较少，但这种异常情况确实存在，与儿童患者的表现不同，需要积极的手术治疗。
本研究纳入了1989年1月至2001年12月期间接受治疗的55例成年原发性梗阻性巨输尿管患者（47例单侧，8例双侧）。对他们的临床表现、肾功能、影像学资料、治疗、并发症及随访情况进行了研究。
55例患者中，男性36例，女性19例（年龄范围13至52岁）。除2例患者外，所有患者均有症状。44例患者（50个肾输尿管单位）需要输尿管再植术，其中33例进行了个体化手术。5例患者接受了内镜技术治疗（3例行输尿管肉阜切开术，2例行输尿管镜下输尿管结石取出术）。4例患者因患肾无功能而需要行肾输尿管切除术。合并的肾结石采用体外冲击波碎石术和肾盂切开取石术治疗，输尿管结石采用内镜方法治疗或在输尿管膀胱吻合术时取出。除4例患者外，所有患者的输尿管积水和肾盂积水均有改善，在1至12年（平均7年）的随访期内未发生并发症。5例双侧巨输尿管患者出现尿毒症。仅1例患者在手术充分引流后病情改善，2例患者尽管进行了再植术仍死亡。
大多数成年巨输尿管患者有症状。结石形成和患肾功能紊乱等并发症很常见，几乎所有患者都需要手术干预。双侧巨输尿管合并晚期肾衰竭患者的手术大多效果不佳。
