Teranishi Jun-ichi, Sato Hiroyuki, Mori Yoshiaki, Asanuma Hiroshi, Shishido Seiichiro
Department of Urology, Tokyo Metropolitan Kiyose Children's Hospital, Japan.
Nihon Hinyokika Gakkai Zasshi. 2006 Mar;97(3):561-7. doi: 10.5980/jpnjurol1989.97.561.
To assess a value of decompression operation for a unilateral ureterocele with a complete duplex system as an initial procedure.
We reviewed records of 33 pediatric patients with a unilateral ureterocele in a complete duplex system who underwent decompression operation between 1987 and 2000. We checked the patient operative age, followup period, position of the ureterocele, type of decompression operation, and additional operation. Furthermore we also checked postoperative vesicoureteral reflux (VUR) in patients who underwent transurethral incision (TUI).
Mean operative age and followup period were 6 months old and 82 months. Of the patients, 22 underwent TUI and 11 underwent upper moiety operation (UMO). In the TUI group, 14 (63.6%) had postoperative VUR and 13 (59.0%) underwent additional operations. These rates were higher in the patients with ectopic ureteroceles than with intravesical ureteroceles. Most additional operations were undergone for the patients with postoperative VUR in TUI group by lower complete reconstructions without UMO. All patients with non-functioning upper moiety underwent heminephrectomy at the additional operations. In the other hand, in the UMO group, 3 (27.3%) had additional operation because of persistent VUR which was found preoperatively in lower moiety or contralateral renal unit.
TUI was useful approach as an initial procedure for intravesical ureteroceles because of low additional operation rate. For ectopic ureteroceles with functioning upper moiety, TUI was high additional operation rate, but it was more useful initial operation of two-staged operation than UMO because of avoiding UMO, like heminephrectomy, at additional operation. UMO was low additional operation rate for ectopic ureteroceles without preoperative VUR of renal unit excluding upper moiety. Especially heminephrectomy was a useful approach as an initial procedure if upper moiety was non-functioning.
评估对伴有完全性重复肾系统的单侧输尿管囊肿进行减压手术作为初始治疗方法的价值。
我们回顾了1987年至2000年间33例伴有完全性重复肾系统的单侧输尿管囊肿且接受了减压手术的儿科患者的记录。我们检查了患者的手术年龄、随访时间、输尿管囊肿的位置、减压手术的类型以及附加手术。此外，我们还检查了接受经尿道切开术（TUI）患者的术后膀胱输尿管反流（VUR）情况。
平均手术年龄和随访时间分别为6个月和82个月。其中，22例患者接受了TUI，11例患者接受了上半肾手术（UMO）。在TUI组中，14例（63.6%）出现术后VUR，13例（59.0%）接受了附加手术。异位输尿管囊肿患者的这些发生率高于膀胱内输尿管囊肿患者。TUI组中大多数附加手术是针对术后出现VUR的患者进行的低位完全重建术，未进行UMO。所有上半肾功能丧失的患者在附加手术时均接受了半肾切除术。另一方面，在UMO组中，3例（27.3%）因术前在下半肾或对侧肾单位发现持续性VUR而接受了附加手术。
由于附加手术率低，TUI是膀胱内输尿管囊肿初始治疗的有效方法。对于上半肾功能良好的异位输尿管囊肿，TUI的附加手术率较高，但由于在附加手术时避免了如半肾切除术等UMO，它比UMO更适合作为两阶段手术中的初始手术。对于不包括上半肾且术前肾单位无VUR的异位输尿管囊肿，UMO的附加手术率较低。特别是当上半肾功能丧失时，半肾切除术作为初始治疗方法是一种有效的途径。
