Parente A, Angulo J M, Romero R M, Rivas S, Tardáguila A R, Corona C
Sección de Urología Infantil, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España.
Actas Urol Esp. 2012 Feb;36(2):117-20. doi: 10.1016/j.acuro.2011.07.005. Epub 2011 Sep 28.
Transurethral puncture or endoscopic unroofing is the best treatment currently used for both orthotopic and ectopic ureteroceles. However, they have a high incidence of secondary vesicoureteral reflux and subsequent procedures in both groups. We present a new technique for treatment of orthotopic ureterocele.
We have analyzed 4 patients with orthotopic ureterocele (9.7 ± 6.2 months old) treated by dilatation of the meatus of the ureterocele. No patient had vesicoureteral reflux or duplicate systems. The indication was pyonephrosis in 2 children and progressive worsening of hydronephrosis in 2. Dilatation was performed with 5 or 6mm high-pressure balloon after inserting a stent with guidewire of 0.014" to the ureterocele.
There were no intraoperative or postoperative complications, surgical time being 24 ± 9minutes. All patients were discharged at 24 postoperative hours. Ureterohydronephrosis disappeared in all the children and they continue asymptomatic after 35 ± 22.5 months of follow-up. There were no cases of secondary vesicoureteral reflux and renal scan was unchanged after treatment.
High pressure balloon dilatation of the meatus in cases of orthotopic ureterocele is a fast, safe and successful surgical technique. We did not find any cases of secondary vesicoureteral reflux or subsequent procedures in our series, so we believe this may offer significant benefits over the transurethral puncture in such patients.
经尿道穿刺或内镜去顶术是目前治疗原位和异位输尿管囊肿的最佳方法。然而，两组患者继发膀胱输尿管反流及后续手术的发生率都很高。我们提出一种治疗原位输尿管囊肿的新技术。
我们分析了4例原位输尿管囊肿患者（年龄9.7±6.2个月），采用输尿管囊肿尿道口扩张术进行治疗。所有患者均无膀胱输尿管反流或重复系统。2例患儿的手术指征为肾盂积脓，2例为肾积水进行性加重。在通过0.014英寸导丝将支架插入输尿管囊肿后，用5或6毫米高压球囊进行扩张。
术中及术后均无并发症，手术时间为24±9分钟。所有患者术后24小时出院。所有患儿的输尿管肾积水均消失，在35±22.5个月的随访后仍无症状。无继发膀胱输尿管反流病例，治疗后肾扫描无变化。
原位输尿管囊肿病例采用尿道口高压球囊扩张术是一种快速、安全且成功的手术技术。在我们的系列研究中未发现继发膀胱输尿管反流或后续手术的病例，因此我们认为，对于此类患者，该方法可能比经尿道穿刺术有显著优势。
