McLeod D J, Alpert S A, Ural Z, Jayanthi V R
Nationwide Children's Hospital, Division of Pediatric Urology and The Ohio State University Medical Center, Timken Hall, G280, 700 Children's Drive, Columbus, OH 43205, USA.
J Pediatr Urol. 2014 Aug;10(4):616-9. doi: 10.1016/j.jpurol.2014.05.003. Epub 2014 Jun 2.
Although ureteroureterostomy (UU) is an established procedure for the treatment of duplex anomalies, there may be a reluctance to apply this approach to patients with poor upper pole function and/or marked degrees of ureteral dilation.
An institutional review board (IRB)-approved retrospective analysis of all patients undergoing UU between 2006 and present was performed. All patients underwent an end-to-side anastomosis with a double-J stent left in the lower pole ureter. Laparoscopic repairs were done 'high' and open repairs were done 'low'. If the upper pole ureter remained massively dilated after transection, the ureter was partially closed to reduce the length of the anastomosis. Data collected included demographics, diagnosis, surgical interventions, imaging studies and outcomes.
A total of 41 patients (43 renal units) were identified. There were 35 females and six males with an average age at surgery of 2.3 years (range 55 days to 15.9 years) and an average follow up of 2.8 years. Diagnosis included ureterocele (17), ectopic duplex ureter (25) and ureteral triplication (1). Thirty-six patients underwent UU only and five underwent UU with simultaneous lower pole reimplantation. Twelve of the 41 patients (29%) underwent laparoscopic repair. Twelve of the 43 renal units (28%) required ureteral tapering, of which three were performed laparoscopically. Preoperative median upper pole function was 17% (0-35%). Six patients had no measurable function and ten had < 15%. No patient developed lower pole hydronephrosis in the follow-up period. There were two complications: one patient was found to have a post-operative ureterovesical junction (UVJ) stricture and the second had an anastomotic stricture.
Ureteroureterostomy is a safe and effective technique for the reconstruction of duplex anomalies, even with a massively dilated and poorly functioning upper pole moiety. With no identifiable negative effect on the lower pole system, the concept of automatically removing 'dysplastic' upper pole segments can be challenged.
尽管输尿管输尿管吻合术（UU）是治疗重复畸形的既定手术方法，但对于上极功能不佳和/或输尿管显著扩张的患者，可能不愿采用这种方法。
对2006年至今所有接受UU手术的患者进行了机构审查委员会（IRB）批准的回顾性分析。所有患者均进行了端侧吻合，并在低位输尿管留置了双J支架。腹腔镜修复在高位进行，开放修复在低位进行。如果横断后上极输尿管仍严重扩张，则部分关闭输尿管以缩短吻合长度。收集的数据包括人口统计学、诊断、手术干预、影像学检查和结果。
共确定41例患者（43个肾单位）。其中女性35例，男性6例，手术平均年龄2.3岁（范围55天至15.9岁），平均随访2.8年。诊断包括输尿管囊肿（17例）、异位重复输尿管（25例）和输尿管三重畸形（1例）。36例患者仅接受了UU手术，5例患者同时进行了低位肾盂再植术。41例患者中有12例（29%）接受了腹腔镜修复。43个肾单位中有12个（28%）需要输尿管缩窄，其中3例通过腹腔镜进行。术前上极功能中位数为17%（0-35%）。6例患者无可测量功能，10例患者功能<15%。随访期间无患者发生低位肾盂积水。有2例并发症：1例患者术后发现输尿管膀胱连接部（UVJ）狭窄，另1例有吻合口狭窄。
输尿管输尿管吻合术是一种安全有效的重建重复畸形的技术，即使上极部分严重扩张且功能不佳。由于对低位系统没有明显的负面影响，自动切除“发育不良”上极节段的观念可能受到挑战。
