Michaud Jason E, Akhavan Ardavan
Department of Urology, Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Charlotte R. Bloomberg Children's Center, Johns Hopkins University, 1800 Orleans St., Bloomberg 7308-B, Baltimore, MD, 21287, USA.
Curr Urol Rep. 2017 Mar;18(3):21. doi: 10.1007/s11934-017-0664-0.
Ureteral duplication and ectopic upper pole ureters are commonly associated with renal pathology, including vesicoureteral reflux, obstruction, infection, and renal function loss. There remains no consensus on the most appropriate management of these complex patients. In this review, we sought to compare existing data on upper pole heminephrectomy with ipsilateral ureteroureterostomy.
Application of magnetic resonance imaging and minimally invasive techniques have led to changes in the diagnosis and treatment of ectopic upper pole ureters. Recent studies have highlighted the safety of laparoscopic and robot-assisted upper pole heminephrectomy and ureteroureterostomy. Minimally invasive approaches to ectopic upper pole ureters appear safe and effective, with complication rates remaining low. Minimally invasive upper pole heminephrectomy carries a higher risk of lower pole function loss. Both upper pole heminephrectomy and ureteroureterostomy carry a small risk of additional surgery on the bladder and remnant ureter.
输尿管重复畸形及异位开口的上极输尿管常与肾脏病变相关，包括膀胱输尿管反流、梗阻、感染及肾功能丧失。对于这些复杂患者的最佳治疗方案，目前尚无共识。在本综述中，我们试图比较关于上极半肾切除术与同侧输尿管输尿管吻合术的现有数据。
磁共振成像和微创技术的应用已导致异位开口上极输尿管的诊断和治疗发生变化。近期研究强调了腹腔镜和机器人辅助上极半肾切除术及输尿管输尿管吻合术的安全性。异位开口上极输尿管的微创治疗方法似乎安全有效，并发症发生率依然较低。微创上极半肾切除术导致下极功能丧失的风险更高。上极半肾切除术和输尿管输尿管吻合术都有对膀胱和残余输尿管进行额外手术的小风险。
