Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Urol. 2011 Oct;186(4):1455-8. doi: 10.1016/j.juro.2011.05.057.
We studied the clinical evolution of vesicoureteral reflux after endoscopic puncture of ureterocele in pediatric duplex systems.
We retrospectively reviewed charts of children with duplex system ureteroceles treated between 1992 and 2007. We analyzed patient age, prenatal diagnosis, urinary tract infection at presentation, differential renal function and preoperative vesicoureteral reflux. The fate of associated vesicoureteral reflux after endoscopic puncture of ureterocele was specifically addressed.
We analyzed 60 patients with a mean age of 12 months, of whom 32 (52%) were diagnosed prenatally and 40 (66%) presented with a urinary tract infection. The majority of ureteroceles were ectopic, and pre-puncture vesicoureteral reflux was seen in 40 patients (67%). Postoperative voiding cystourethrogram was performed in 50 cases. New onset of vesicoureteral reflux occurred postoperatively in 24 patients (40%), mainly ipsilateral to the lower pole or contralaterally. Spontaneous vesicoureteral reflux resolution or improvement occurred in 16 of 22 patients (72%) observed after primary endoscopic puncture of ureterocele. Surgical intervention after endoscopic puncture of ureterocele was performed in 25 patients (42%), of whom 9 underwent more than 1 reparative procedure.
Vesicoureteral reflux after endoscopic puncture of ureterocele may occur in the ipsilateral upper or lower poles, or in the contralateral renal segments. Therefore, the reflux is not necessarily related to the puncture itself. Vesicoureteral reflux after endoscopic puncture of ureterocele can resolve spontaneously in a significant number of patients. Therefore, initial management by close surveillance is warranted. Considering the simplicity of the procedure, our findings support that endoscopic puncture of ureterocele is an attractive alternative for the initial management of pediatric duplex system ureteroceles.
我们研究了儿童双肾盂输尿管重复畸形合并输尿管囊肿经内镜穿刺术后的上尿路反流临床演变过程。
我们回顾性分析了 1992 年至 2007 年间治疗的双肾盂输尿管重复畸形合并输尿管囊肿患儿的病历。分析患者的年龄、产前诊断、就诊时的尿路感染、分肾功能及术前上尿路反流情况。特别分析了内镜下穿刺治疗输尿管囊肿后并发的上尿路反流的转归。
共分析了 60 例患儿，平均年龄 12 个月，32 例（52%）患儿有产前诊断，40 例（66%）患儿就诊时有尿路感染。大多数输尿管囊肿为异位性，40 例（67%）患儿术前有上尿路反流。50 例行术后排尿性膀胱尿道造影。24 例（40%）患儿术后出现新发上尿路反流，主要为同侧下极或对侧。22 例（72%）患儿行初次内镜下穿刺治疗输尿管囊肿后，反流自发缓解或改善。25 例（42%）患儿在接受内镜下穿刺治疗输尿管囊肿后需要进一步手术干预，其中 9 例接受了 1 次以上的修复手术。
输尿管囊肿内镜下穿刺术后可能出现同侧上极或下极、或对侧肾盂输尿管反流，因此，反流不一定与穿刺本身有关。内镜下穿刺治疗输尿管囊肿后，相当一部分患儿的反流可自发缓解，因此，密切观察是初始治疗的首选。考虑到操作简单，我们的发现支持对儿童双肾盂输尿管重复畸形合并输尿管囊肿采用内镜下穿刺治疗作为初始治疗方法。
