Picart B, Pons M, Line A, François C, Poli Merol M-L
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
Prog Urol. 2017 Feb;27(2):103-109. doi: 10.1016/j.purol.2016.12.009. Epub 2017 Feb 4.
What is the proper way to manage complicated primary mega-ureter in infants under the age of one. This has already been discussed in the literature but the controversy remains.
Evaluate the long-term results of the management of mega-ureter based support under the age of one.
Single-center retrospective study from 1990 to 2010. All children under one year found were evaluated including clinical examination, ultrasound, scintigraphy and cystography. They were divided into two groups: group 1: children operated on before the age of one year, group 2 non-operated or operated children after the age of one year. We analyzed the long-term evolution of these children on the following criteria: reflux, pyelonephritis, changes in dilation, renal function, need for surgical revision or secondary surgery, and impact on bladder function.
In total, 54 patients were included in group 1 and 56 patients in group 2. In a median follow-up of 12 years. A total of 101 boys and 9 girls (sex-ratio 11.22). There were 57 left MUP (52%), 22 right (20%) and 31 bilateral (28%). A total of 71% of antenatal diagnosis. No difference on the emergence of complications: 25 (group 1) versus 31 (group 2) OR=0.69; 95% (0.307; 1.574); P=0.44. No difference between secondary surgery and revision surgery: group 1=12, group 2=22, OR=0.45; 95% CI (0.17, 1.09); P=0.06. No difference for daytime incontinence: OR=1.04; 95% CI (0.14; 7.64); P=0.67. Seventy-six children (69%) were finally made, 12 children operated twice (10.9%) and 34 children (31%) never made.
The main challenge of the MUP of management is the preservation of renal function. Sixty-nine percent of our children received surgery due to impaired renal function lower than 30% of urethral dilatation greater than 10mm associated with reflux or recurrent pyelonephritis. Clinical monitoring, regular ultrasound and isotopic testing are necessary and should be extended to adulthood.
对于1岁以下婴儿复杂原发性巨输尿管的恰当处理方法是什么。这一问题在文献中已有讨论，但争议仍然存在。
评估1岁以下以巨输尿管为基础的治疗的长期效果。
1990年至2010年的单中心回顾性研究。对所有1岁以下儿童进行评估，包括临床检查、超声、闪烁扫描和膀胱造影。他们被分为两组：第1组：1岁前接受手术的儿童；第2组：1岁后未接受手术或接受手术的儿童。我们根据以下标准分析这些儿童的长期演变情况：反流、肾盂肾炎、扩张变化、肾功能、手术修正或二次手术的需求以及对膀胱功能的影响。
第1组共纳入54例患者，第2组共纳入56例患者。中位随访时间为12年。共有101名男孩和9名女孩（性别比为11.22）。左侧巨输尿管57例（52%），右侧22例（20%），双侧31例（28%）。产前诊断率为71%。并发症发生率无差异：第1组25例，第2组31例，OR = 0.69；95%（0.307；1.574）；P = 0.44。二次手术和修正手术之间无差异：第1组 = 12例，第2组 = 22例，OR = 0.45；95% CI（0.17，1.09）；P = 0.06。日间尿失禁无差异：OR = 1.04；95% CI（0.14；7.64）；P = 0.67。最终治愈76例儿童（69%），12例儿童接受了两次手术（10.9%），34例儿童（31%）未治愈。
巨输尿管治疗的主要挑战是保护肾功能。我们69%的儿童因肾功能受损、尿道扩张超过10mm且伴有反流或复发性肾盂肾炎导致肾功能低于30%而接受手术。临床监测、定期超声和同位素检测是必要的，并且应持续到成年期。
5级
