Kagantsov I M, Sizonov V V, Dubrov V I, Bondarenko S G, Akramov N R, Shmyrov O S, Kuzovleva G I, Surov R V, Logval A A
Republican Childrens Clinical Hospital, Syktyvkar, Russia.
Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia.
Urologiia. 2018 May(2):83-88.
The duplex kidney is one of the most common congenital abnormalities of the urinary tract, and various surgical procedures exist for the management of this condition. Depending on the surgeon preferences, patients with duplex kidney may undergo heminephrectomy with ureterectomy using open or laparoscopic approach, uretero-cysto-anastomosis of the ectopic ureter or two ureters in a single block. Recently, there have been reports of inter-ureter anastomoses. Here we report our multicenter experience in open and laparoscopic uretero-ureteral anastomosis (UUA). The study aimed to improve the treatment results in children with urodynamic dysfunction due to the duplicated upper urinary tract.
We retrospectively analyzed medical records of 64 children treated from 2007 to 2017. There were 22 (32.8%) boys and 43 (67.2%) girls with mean age 40.2 months at the time of surgery. All of them had duplex kidneys, including 27 (42.2%) right-sided and 37 (57.8%) left-sided. Of them, 15 (23.4%) children underwent distal UUA (DUAA), and 49 (76.6%) had proximal UUA (PUUA).
After surgery, acute pyelonephritis occurred in three patients. In the early postoperative period, a prolonged urinary leakage from surgical site drainage was observed in three (6.1%) patients after laparoscopic PUUA. One (4.2%) child developed a stumpitis. Thus, complications occurred in 7 (10.9%) children; one of them (1.6%) needed additional treatment.
Distal and proximal UUA is a safe and effective surgical treatment for urinary outflow disorders in patients with the duplicated upper urinary tract, minimizing the risk of the duplex kidney dysfunction.
重复肾是最常见的先天性泌尿道畸形之一，针对这种病症有多种外科手术方法。根据外科医生的偏好，重复肾患者可采用开放或腹腔镜手术方式进行半肾切除术并切除输尿管、对异位输尿管或两条输尿管进行输尿管膀胱吻合术。最近，有输尿管间吻合术的相关报道。在此，我们报告我们在开放和腹腔镜输尿管输尿管吻合术（UUA）方面的多中心经验。本研究旨在改善因上尿路重复导致尿动力学功能障碍患儿的治疗效果。
我们回顾性分析了2007年至2017年期间接受治疗的64例患儿的病历。其中男孩22例（32.8%），女孩43例（67.2%），手术时平均年龄为40.2个月。所有患儿均为重复肾，其中右侧27例（42.2%），左侧37例（57.8%）。其中，15例（23.4%）患儿接受了远端UUA（DUAA），49例（76.6%）接受了近端UUA（PUUA）。
术后，3例患者发生急性肾盂肾炎。在术后早期，3例（6.1%）接受腹腔镜PUUA的患者手术部位引流出现持续性尿漏。1例（4.2%）患儿发生残端炎。因此，7例（10.9%）患儿出现并发症；其中1例（1.6%）需要进一步治疗。
远端和近端UUA是治疗上尿路重复患者尿流障碍的一种安全有效的手术方法，可将重复肾功能障碍的风险降至最低。
