Haddad Joseph, Meenakshi-Sundaram Bhalaajee, Rademaker Nathan, Greger Hubert, Aston Christopher, Palmer Blake W, Kropp Bradley P, Frimberger Dominic
Department of Pediatric Urology, University of Oklahoma Health Sciences Center and Children's Hospital of Oklahoma, Oklahoma City, OK.
Department of Pediatric Urology, University of Oklahoma Health Sciences Center and Children's Hospital of Oklahoma, Oklahoma City, OK.
Urology. 2017 Oct;108:161-165. doi: 10.1016/j.urology.2017.06.008. Epub 2017 Jun 15.
To assess the outcomes of "watering can" ureterocele puncture (WCP), a technique previously associated with decreased incidence of de novo vesicoureteral reflux (VUR), as a durable option for management of ureteroceles and to determine the need for subsequent surgery for VUR following watering can puncture.
We retrospectively reviewed records of 55 consecutive endoscopic ureterocele procedures performed at our institution from 1999 to 2015. The WCP was performed using a holmium laser fiber to make 10-20 puncture holes through the ureterocele. Follow-up data were collected on infection, de novo VUR in the affected renal moiety and the need for further treatment and surgery.
Of 55 patients who underwent endoscopic ureterocele management, 34 underwent WCP and 21 patients underwent either incision or puncture. Median follow-up was 3.4 and 2.8 years in the incision and puncture groups, respectively. Both groups had similar rates of ureterocele decompression (88% vs 90%; P >.05) and improvement in hydronephrosis (82% vs 81%; P >.05). The WCP group had a significantly decreased rate of de novo VUR (32% vs 67%; P <.05) and of subsequent surgery due to de novo VUR (38% vs 71%; P <.05). The average grade of de novo VUR was lower in the WCP group (1.4 vs 2.8; P <.05).
Our study shows that the endoscopic WCP successfully decompresses the obstructing ureterocele and results in a decreased incidence of de novo VUR and ultimately in fewer invasive procedures for the patient. This update demonstrates the durable outcomes of this novel technique.
评估“洒水壶”式输尿管囊肿穿刺术（WCP）的治疗效果，该技术此前被认为可降低新发膀胱输尿管反流（VUR）的发生率，作为输尿管囊肿治疗的一种持久选择，并确定在进行洒水壶穿刺术后因VUR而需要后续手术的必要性。
我们回顾性分析了1999年至2015年在我院连续进行的55例内镜下输尿管囊肿手术记录。使用钬激光光纤进行WCP，在输尿管囊肿上制造10至20个穿刺孔。收集有关感染、患侧肾部新发VUR以及进一步治疗和手术需求的随访数据。
在接受内镜下输尿管囊肿治疗的55例患者中，34例行WCP，21例患者行切开或穿刺术。切开组和穿刺组的中位随访时间分别为3.4年和2.8年。两组输尿管囊肿减压率（88%对90%；P＞0.05）和肾积水改善率（82%对81%；P＞0.05）相似。WCP组新发VUR发生率（32%对67%；P＜0.05）及因新发VUR而进行后续手术的发生率（38%对71%；P＜0.05）显著降低。WCP组新发VUR的平均分级较低（1.4对2.8；P＜0.05）。
我们的研究表明，内镜下WCP成功解除了梗阻性输尿管囊肿，降低了新发VUR的发生率，最终减少了患者的侵入性手术。本研究结果证明了这项新技术的持久疗效。
