Elmore James M, Kirsch Andrew J, Perez-Brayfield Marcos R, Scherz Hal C, Koyle Martin A
Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, 5445 Meridian Mark Road, Atlanta, GA 30342, USA.
J Urol. 2006 Sep;176(3):1158-60. doi: 10.1016/j.juro.2006.04.050.
Open intravesical ureteral reimplantation has been reported to be uncomplicated following dextranomer/hyaluronic acid implantation. However, there are no known reports regarding extravesical ureteral reimplantation following dextranomer/hyaluronic acid failure. We reviewed our experience with extravesical ureteral reimplantation after dextranomer/hyaluronic acid failure.
We reviewed the charts of 30 patients who underwent extravesical ureteral reimplantation after dextranomer/hyaluronic acid failure. If reflux was initially bilateral and only a unilateral cure was achieved, the cured ureter was not reimplanted. Intraoperative complications, need for stenting or prolonged bladder catheterization, length of hospitalization and radiographic results were noted.
At cystoscopy the dextranomer/hyaluronic acid implants were not seen in half of the patients. In the remaining 15 patients the blebs had moved caudally and/or were seen extravesically at the ureteral hiatus or along Waldeyer's sheath. Unilateral extravesical ureteral reimplantation was performed without difficulty in all patients and there were no intraoperative complications. Stents were left indwelling only in those patients who had undergone dismembered ureteral reimplantation. No patient required prolonged bladder drainage. All patients except 2 who had undergone additional procedures were discharged home within 24 hours postoperatively. There was no evidence of obstruction on postoperative renal sonography, and extravesical ureteral reimplantation was confirmed to be successful in all 24 patients with postoperative voiding cystourethrograms.
Extravesical ureteral reimplantation can be performed without difficulty following dextranomer/hyaluronic acid implantation. Since extravesical ureteral reimplantation is less morbid and better tolerated than intravesical reimplantation, it is an excellent treatment option for patients with persistent unilateral vesicoureteral reflux following dextranomer/hyaluronic acid implantation. Furthermore, in cases in which vesicoureteral reflux is initially bilateral our data suggest that reimplantation of the successfully treated contralateral ureter can be avoided.
据报道，葡聚糖凝胶/透明质酸植入术后行开放性膀胱内输尿管再植术并无并发症。然而，尚无关于葡聚糖凝胶/透明质酸治疗失败后行膀胱外输尿管再植术的报道。我们回顾了我们在葡聚糖凝胶/透明质酸治疗失败后行膀胱外输尿管再植术的经验。
我们回顾了30例在葡聚糖凝胶/透明质酸治疗失败后接受膀胱外输尿管再植术患者的病历。如果最初反流为双侧性且仅单侧治愈，则已治愈的输尿管不再进行再植。记录术中并发症、是否需要置入支架或延长膀胱插管时间、住院时间及影像学检查结果。
膀胱镜检查时，半数患者未见葡聚糖凝胶/透明质酸植入物。在其余15例患者中，水泡向尾侧移动和/或在输尿管裂孔处或沿瓦尔代尔鞘膜在膀胱外可见。所有患者均顺利进行了单侧膀胱外输尿管再植术，无术中并发症。仅在那些接受了离断性输尿管再植术的患者中留置支架。无一例患者需要延长膀胱引流时间。除2例接受了额外手术的患者外，所有患者均在术后24小时内出院。术后肾脏超声检查未发现梗阻迹象，术后排尿性膀胱尿道造影证实所有24例患者的膀胱外输尿管再植术均成功。
葡聚糖凝胶/透明质酸植入术后行膀胱外输尿管再植术并不困难。由于膀胱外输尿管再植术比膀胱内再植术的发病率更低且耐受性更好，因此对于葡聚糖凝胶/透明质酸植入术后持续存在单侧膀胱输尿管反流的患者而言，它是一种极佳的治疗选择。此外，在膀胱输尿管反流最初为双侧性的病例中，我们的数据表明可以避免对已成功治疗的对侧输尿管进行再植。
