Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, 2705 boulevard Laurier, R-1742, Québec, Canada.
J Pediatr Urol. 2013 Jun;9(3):339-43. doi: 10.1016/j.jpurol.2012.04.009. Epub 2012 Jun 9.
A systematic initial endoscopic approach has been locally adopted since 2002 for the treatment of ureterocele. Our aim was to compare outcomes for patients treated with this approach to those treated prior to this date.
We reviewed the charts of 145 children with ureteroceles treated surgically between 1992 and 2010. Patients were divided according to ureterocele position, year of treatment and type of initial intervention. Evaluation was completed by ultrasound, voiding cystourethrogram and nuclear renal scans.
Mean age at initial surgery was 18 months. Group 1 comprised 68 patients operated before 2002, and Group 2 66 patients operated after 2002. Group 1 patients showed a higher rate of preoperative vesicoureteral reflux. Mean follow-up was 43 and 25 months for group 1 and 2, respectively. Ureteroceles treated endoscopically underwent secondary procedures in 61% (group 1) and 42% (group 2) for ectopic and in 42% (group 1) and 10% (group 2) for orthotopic ureteroceles. Overall, there was more de novo upper moiety VUR in group 1 (48% vs 12%).
Primary endoscopic ureterocele treatment seems to be an appropriate option for children with a clinically significant ureterocele. The rate of secondary procedures was higher for ectopic ureteroceles but acceptable compared to the upper tract approach.
自 2002 年以来，我们局部采用了系统的初始内镜方法来治疗输尿管口囊肿。我们的目的是比较采用这种方法治疗的患者与在此之前治疗的患者的结果。
我们回顾了 1992 年至 2010 年间接受手术治疗的 145 例输尿管口囊肿患儿的病历。根据输尿管口囊肿的位置、治疗年份和初始干预类型对患者进行分组。通过超声、排尿性膀胱尿道造影和核肾扫描进行评估。
初次手术的平均年龄为 18 个月。第 1 组包括 2002 年之前手术的 68 例患者，第 2 组包括 2002 年之后手术的 66 例患者。第 1 组患者术前膀胱输尿管反流的发生率更高。第 1 组和第 2 组的平均随访时间分别为 43 个月和 25 个月。内镜治疗的输尿管口囊肿中，61%（第 1 组）和 42%（第 2 组）的异位输尿管口囊肿需要二次手术，42%（第 1 组）和 10%（第 2 组）的正常输尿管口囊肿需要二次手术。总体而言，第 1 组有更多新发性上半部分 VUR（48% vs. 12%）。
对于有临床意义的输尿管口囊肿患儿，原发性内镜输尿管口囊肿治疗似乎是一种合适的选择。异位输尿管口囊肿的二次手术率较高，但与上尿路入路相比可以接受。
