Section of Pediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Monoblocco Ospedaliero, via Giustiniani 2, Padua 35128, Italy.
Nat Rev Urol. 2009 Jun;6(6):307-15. doi: 10.1038/nrurol.2009.82.
Ureteroceles associated with the upper pole of a complete ureteral duplication are known as duplex system ureteroceles (DSUs). A limited knowledge of the natural history of this condition makes its management in neonates and infants controversial. Asymptomatic neonates diagnosed antenatally in the absence of severe hydroureteronephrosis (HUN) are at low risk of developing urinary tract infections during the first months of life. These patients might, therefore, begin antibiotic prophylaxis and undergo comprehensive assessment by 3-6 months. Subsequently, conservative management can be viable in patients without severe HUN or high-grade vesicoureteral reflux (VUR). Cases of DSUs with severe HUN but no VUR can be treated by an upper urinary tract approach or by endoscopic decompression depending on upper pole function. Patients with preoperative VUR represent the most challenging cases. If VUR cure is considered necessary, lower urinary tract reconstruction is recommended. Endoscopic decompression allows for a definitive treatment in at least 50% of cases and, in the remaining cases, can be combined with conservative management or endoscopic treatment of VUR. Nonfunctioning or poorly functioning upper poles can be left in situ both in lower urinary tract reconstruction and after endoscopic decompression. Parental preferences should also be taken into account in the decision-making process.
输尿管口囊肿与完全性重复输尿管的上段相关，被称为重复输尿管系统输尿管口囊肿（DSU）。由于对这种情况的自然病史了解有限，因此在新生儿和婴儿中对其进行管理存在争议。在没有严重肾积水（HUN）的情况下，产前诊断为无症状的新生儿在生命的头几个月发生尿路感染的风险较低。因此，这些患者可能在 3-6 个月时开始进行抗生素预防，并进行全面评估。随后，如果没有严重的 HUN 或高级别膀胱输尿管反流（VUR），则可以对患者进行保守治疗。对于有严重 HUN 但没有 VUR 的 DSU 病例，可以根据上极功能通过上尿路途径或内镜减压进行治疗。术前存在 VUR 的病例是最具挑战性的。如果认为有必要治愈 VUR，则建议进行下尿路重建。内镜减压可使至少 50％的病例得到确定性治疗，在其余病例中，可与保守治疗或 VUR 的内镜治疗相结合。在进行下尿路重建和内镜减压后，非功能或功能不良的上极可以保留在原位。在决策过程中，还应考虑父母的意愿。
