Pediatric Renal Center, University Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
J Urol. 2013 Jan;189(1):295-9. doi: 10.1016/j.juro.2012.09.004. Epub 2012 Nov 20.
A duplex collecting system is a common congenital renal tract abnormality associated with different clinical problems. We describe our experience with ureteral reimplantations of a complete duplex collecting system where 1 megaureter needing recalibration and 1 normal-sized ureter coexisted. Recalibration of the megaureter was done by wrap plication around the normal-sized ureter.
Operative logs and case notes were reviewed of consecutive children with a complete duplex collecting system treated with wrap plication of the megaureter around the normal-sized ureter and reimplantation between 1997 and 2010. Reoperation, vesicoureteral reflux and obstruction rates were assessed.
A total of 25 children underwent wrap plication and ureteral reimplantation. Of the cases 19 (76%) were completely successful and 6 (24%) needed reoperation. Three children (12%) had persistent high grade vesicoureteral reflux, 2 (8%) underwent endoscopic correction and 1 (4%) underwent repeat reimplantation of the duplex system. Three children (12%) had postoperative obstruction and 2 (8%) underwent endoscopic incision of the ureteral orifice. In 1 child (4%) a nonfunctioning lower moiety of the kidney developed, which was managed by heminephrectomy.
Wrap plication of a megaureter around the normal-sized ureter before reimplantation seems to be a relatively safe method in the surgical management of children with a complete duplex collecting system of the kidney. Sufficient spatulation of the lower pole ureter seems to be crucial.
双肾盂输尿管收集系统是一种常见的先天性肾输尿管异常，与不同的临床问题有关。我们描述了我们在完全性双肾盂输尿管收集系统中进行输尿管再植入术的经验，其中 1 个巨输尿管需要重新校准，1 个正常大小的输尿管共存。巨输尿管的重新校准是通过围绕正常大小的输尿管进行包裹折叠来完成的。
回顾了 1997 年至 2010 年间连续接受巨输尿管围绕正常大小输尿管包裹折叠和再植入术治疗的完全性双肾盂输尿管收集系统儿童的手术记录和病例记录。评估了再次手术、膀胱输尿管反流和梗阻的发生率。
共有 25 名儿童接受了包裹折叠和输尿管再植入术。19 例（76%）完全成功，6 例（24%）需要再次手术。3 例（12%）持续存在高等级膀胱输尿管反流，2 例（8%）经内镜矫正，1 例（4%）再次行双肾盂系统再植入术。3 例（12%）术后发生梗阻，2 例（8%）经内镜切开输尿管口。1 例（4%）患儿出现下极肾脏无功能，行半肾切除术治疗。
在进行再植入术前，将巨输尿管包裹在正常大小的输尿管周围，似乎是治疗完全性双肾盂输尿管收集系统儿童的一种相对安全的方法。充分切开下极输尿管似乎是至关重要的。
