Barrieras Diego, Lapointe Steven, Houle Houle
Hospital Sainte-Justine, Université de Montréal, Québec, Canada.
J Urol. 2003 Oct;170(4 Pt 2):1545-7; discussion 1547. doi: 10.1097/01.ju.0000084149.02826.64.
We evaluate the outcome vesicoureteral reflux (VUR) in duplicated collecting systems compared to single collecting systems corrected using an extravesical detrusorrhaphy approach.
We reviewed the records of 266 patients (422 ureters) treated for VUR using an extravesical approach between 1991 and 2001. Inclusion criteria were primary reflux in single (201 patients, 125 bilateral) or duplicated collecting systems (65, 31 bilateral) in patients not undergoing other concomitant surgery with at least 1 year of postoperative followup. The indication for surgical intervention was unresolved reflux (greater than 4 years) in more than 70% of patients. Postoperative evaluation included a voiding cystourethrogram at 3 months and 12 months if reflux was unresolved at 3 months. Also ultrasound was performed at 6 weeks or earlier if clinically indicated and 12 months.
Group 1 (duplicated collecting systems) and group 2 (single collecting systems) were comparable for age, sex distribution and reflux grade distribution. Overall success rate at 3 and 12 months was 94.7% and 98.9% for group 1, and 95.1% and 98.5% for group 2, respectively. The difference in success rate at 3 and 12 months was not statistically significant (p >0.05). Of note in both groups postoperative VUR was contralateral in more than 40% of cases. Postoperative hydronephrosis (Society for Fetal Urology grade 1, 2 or 1 increment in grade from preoperative status) was observed in 5.3% and 7.3% of ureteral units at 6 weeks in groups 1 and 2, respectively (p >0.05). At 12 months less than 1% of ureteral units exhibited low grade residual hydronephrosis. No high grade postoperative hydronephrosis was observed in either group, and there were no intraoperative complications. Postoperative urinary retention occurred in 4.7% and 4% of patients in groups 1 and 2, respectively (p >0.05).
Common sheath extravesical reimplantation is highly effective in treating VUR. The common sheath extravesical reimplantation for duplicated collecting systems is as effective in nonduplicated systems and is associated with minimal perioperative morbidity.
我们评估重复集合系统中膀胱输尿管反流（VUR）的治疗结果，并与采用膀胱外逼尿肌缝合术矫正的单一集合系统进行比较。
我们回顾了1991年至2001年间采用膀胱外方法治疗VUR的266例患者（422条输尿管）的记录。纳入标准为单集合系统（201例患者，125例双侧）或重复集合系统（65例，31例双侧）中的原发性反流，患者未接受其他同期手术，且术后随访至少1年。手术干预的指征是超过70%的患者反流未缓解（超过4年）。术后评估包括术后3个月时的排尿性膀胱尿道造影，如果3个月时反流未缓解，则在12个月时进行。如果临床有指征，还在6周或更早以及12个月时进行超声检查。
第1组（重复集合系统）和第2组（单一集合系统）在年龄、性别分布和反流分级分布方面具有可比性。第1组在3个月和12个月时的总体成功率分别为94.7%和98.9%，第2组分别为95.1%和98.5%。3个月和12个月时成功率的差异无统计学意义（p>0.05）。值得注意的是，两组中超过40%的病例术后VUR为对侧。第1组和第2组在6周时分别有5.3%和7.3%的输尿管单位观察到术后肾积水（胎儿泌尿外科学会1级、2级或比术前状态等级增加1级）（p>0.05）。在12个月时，不到1%的输尿管单位表现为轻度残余肾积水。两组均未观察到重度术后肾积水，且无术中并发症。第1组和第2组分别有4.7%和4%的患者发生术后尿潴留（p>0.05）。
共同鞘膀胱外再植术治疗VUR非常有效。重复集合系统的共同鞘膀胱外再植术在单一集合系统中同样有效，且围手术期发病率极低。
