Department of Urology, Naval Medical Center San Diego , San Diego, California.
J Endourol. 2018 Jun;32(6):482-487. doi: 10.1089/end.2017.0434.
The gold standard treatment for primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent infections is ureteral reimplantation with or without tapering. In infants, open surgery can be technically demanding and associated with significant morbidity. We conducted a systematic review of the literature with special interest in endoscopic management of POM and its outcomes.
A search was conducted of the MEDLINE/Ovid, PubMed, Embase, and Web of Science databases. Only full-text articles written in the English language and involving greater than one reported pediatric case per publication were included. Two authors independently extracted data and assessed strength of evidence for each study.
We found 11 retrospective and 1 prospective, single institution case series that met selection criteria, describing 222 patients with 237 obstructed renal units. Mean age at time of surgery was 24.6 months. The most common endoscopic approaches were cystoscopy+high-pressure balloon dilation+Double-J ureteral stent placement (49.5%), cystoscopy+incisional ureterotomy+Double-J ureteral stent placement (27.8%), and cystoscopy+Double-J ureteral stent placement (18.9%). For all approaches and age groups, anatomic and functional success rates were 79.3% (146/184) and 76.7% (132/172), respectively. Anatomic success rates were highest in children ≥12 months of age (82.3%, 117/142). Endoscopic retreatment was performed in 15.1% of cases with a 36.7% overall surgical reintervention rate. Forty-one ureters progressed to ureteral reimplantation. Complications were generally mild (Clavien-Dindo Grades I-II), but 12 ureters did develop vesicoureteral reflux. Mean follow-up period was 3.2 years.
Endoscopic management for persistent or progressive POM in children ≥12 months of age is a minimally invasive alternative to ureteral reimplantation with modest success rates. In infants, it may best be utilized as a temporizing procedure. Approximately one-third of patients require surgical reintervention.
对于原发性梗阻性巨输尿管症（POM），如果肾功能下降、梗阻加重或反复感染，金标准治疗方法是输尿管再植入术，可加或不加缩窄术。对于婴儿，开放性手术可能具有较高的技术要求，且相关并发症较多。我们对文献进行了系统回顾，特别关注了 POM 的内镜治疗及其结果。
对 MEDLINE/Ovid、PubMed、Embase 和 Web of Science 数据库进行了检索。仅纳入全文文献，且每种出版物报道的儿童病例数均大于 1 例，文献语言为英文。两位作者独立提取数据，并对每项研究的证据强度进行评估。
我们共发现 11 项回顾性和 1 项前瞻性单机构病例系列研究符合入选标准，共描述了 222 例 237 个梗阻性肾脏单位。手术时的平均年龄为 24.6 个月。最常见的内镜方法是膀胱镜检查+高压球囊扩张+双 J 输尿管支架置入（49.5%）、膀胱镜检查+切开性输尿管切开术+双 J 输尿管支架置入（27.8%）和膀胱镜检查+双 J 输尿管支架置入（18.9%）。对于所有方法和年龄组，解剖学成功率和功能成功率分别为 79.3%（146/184）和 76.7%（132/172）。12 个月以上儿童的解剖学成功率最高（82.3%，117/142）。15.1%的病例需要内镜治疗，整体手术再干预率为 36.7%。41 个输尿管进展为输尿管再植入术。并发症通常较轻（Clavien-Dindo 分级 I-II 级），但 12 个输尿管发生了膀胱输尿管反流。平均随访时间为 3.2 年。
对于 12 个月以上儿童持续性或进行性 POM，内镜治疗是一种替代输尿管再植入术的微创方法，成功率适中。对于婴儿，它可能最好作为一种临时治疗方法。约三分之一的患者需要手术再干预。
