Tehran University of Medical Sciences, Tehran, Iran.
Urology. 2013 Jul;82(1):214-9. doi: 10.1016/j.urology.2013.02.048. Epub 2013 Apr 17.
To present the results of our experience with endoureterotomy as the initial management of ureterovesical junction obstruction (UVJO) with coexisting primary or secondary obstruction at the ureteropelvic junction (UPJO) level.
A total of 490 children with 561 ureterorenal units were referred to our center for further management of UVJO. Of these, 47 ureterorenal units had concomitant UPJO. All patients underwent endoureterotomy. Patients were monitored by performing clinical examinations, urine culture, ultrasonography, and radionuclide renal scan.
Mean procedure time for endoureterotomy was 20 minutes (range, 14-33 minutes). No postoperative complications were observed. With a mean follow-up of 27 months, 39 of the 47 ureters with concomitancy (82.97%) showed resolution of both pathologies after the initial endoureterotomy, and 4 patients experienced resolution after redo endoureterotomy, with an overall success rate of 91.48%. Three ureterorenal units (6.38%) underwent further ureteral reimplantation. Pyeloplasty was performed on 3 ureterorenal units (6.38%), which led to complete resolution in all.
Performing initial endoureterotomy for the management of UVJO concomitant with UPJO provides promising results in spontaneous resolution of UPJO and complete resolution or decrease in hydronephrosis and can be proposed as an effective and safe temporizing alternative in selected patients.
介绍我们在处理伴有肾盂输尿管连接部（UPJO）原发性或继发性梗阻的输尿管膀胱连接部（UVJO）时，以内镜下输尿管切开术作为初始治疗的经验结果。
共有 490 名儿童的 561 个输尿管肾单位被转介到我们中心进一步治疗 UVJO。其中 47 个输尿管肾单位伴有并发的 UPJO。所有患者均接受了内镜下输尿管切开术。通过临床检查、尿液培养、超声检查和放射性核素肾扫描对患者进行监测。
内镜下输尿管切开术的平均手术时间为 20 分钟（范围 14-33 分钟）。术后无并发症发生。平均随访 27 个月后，47 个并发输尿管中有 39 个（82.97%）在初始内镜下输尿管切开术后两种病变均得到缓解，4 个患者在再次内镜下输尿管切开术后得到缓解，总体成功率为 91.48%。3 个输尿管肾单位（6.38%）行进一步的输尿管再植入术。3 个输尿管肾单位（6.38%）行肾盂成形术，均完全缓解。
对于伴有 UPJO 的 UVJO 行初始内镜下输尿管切开术，在 UPJO 的自发性缓解、完全缓解或积水减少方面取得了有前景的结果，可作为有选择的患者的有效且安全的临时替代方案。
