Department of Pediatric Surgery, Christian Medical College, Vellore, India.
Department of Pediatric Surgery, Christian Medical College, Vellore, India.
J Pediatr Urol. 2018 Dec;14(6):541.e1-541.e5. doi: 10.1016/j.jpurol.2018.05.004. Epub 2018 Jun 7.
Primary obstructive megaureters (POM) can be treated with one of the following options: conservative management with antibiotic chemoprophylaxis and active observation of the hydroureteronephrosis (HUN) until suspicion of renal deterioration; refluxing/non-refluxing ureteric reimplantation with antibiotic suppression; temporary double-J stenting; endoscopic balloon dilatation; endoureterotomy; and end cutaneous ureterostomy (ECU).
To study the profile of patients with POM and assess the efficacy, safety and outcome of ECU as an interim procedure.
A retrospective review was performed of patients who underwent ECU for POM between January 2004 and December 2014. Demographics, surgical details, and outcomes were studied.
A total of 25 patients (19 males, six females) underwent ECU of 25 renal units for POM at a mean age of 7 months (range 23 days to 2.5 years). Of these, nine had presented with radiological worsening of antenatally detected HUN, 12 had symptoms (urosepsis in nine and palpable hydronephrosis in three), three had a solitary kidney in renal failure, and one had incidentally diagnosed renal cortical thinning as shown in Table below. Following diversion, renal failure had resolved in all, and febrile urinary tract infection (UTI) developed in one while awaiting reimplantation. Undiversion was performed in 21/25 patients at a mean duration of 12 months after diversion and a mean age of 19 months. In these, the ureteric size had decreased significantly at reimplantation. In 4/25, undiversion was not performed due to loss of follow-up in two and a subsequent nephrectomy in two. Two out of 21 developed febrile UTI after undiversion. The overall mean follow-up period was 34.2 months (n = 25), while the mean follow-up after undiversion was 41.5 months (n = 21). There was no incidence of stomal complications.
End cutaneous ureterostomy was a safe and effective temporary procedure for the treatment of progressive primary obstructive megaureters.
原发性梗阻性巨输尿管（POM）可采用以下治疗方案之一：保守治疗，即使用抗生素进行化学预防，并积极观察肾盂积水（HUN），直到怀疑肾损害；反流/非反流输尿管再植术，并用抗生素抑制；暂时性双 J 支架置入术；内镜球囊扩张术；腔内输尿管切开术；以及经皮输尿管造口术（ECU）。
研究 POM 患者的特征，并评估 ECU 作为临时手术的疗效、安全性和结果。
对 2004 年 1 月至 2014 年 12 月期间接受 ECU 治疗的 POM 患者进行回顾性分析。研究了患者的人口统计学、手术细节和结果。
共 25 例患者（19 名男性，6 名女性），因 POM 行 25 个肾脏的 ECU 治疗，平均年龄为 7 个月（范围 23 天至 2.5 岁）。其中，9 例在产前发现 HUN 加重时出现影像学恶化，12 例有症状（9 例为脓毒症，3 例为可触及的肾盂积水），3 例为肾衰竭单肾，1 例为偶然发现的肾皮质变薄，如下表所示。在进行引流后，所有患者的肾功能衰竭均得到缓解，1 例在等待再植时发生发热性尿路感染（UTI）。21 例患者中的 21 例在引流后平均 12 个月且平均年龄为 19 个月时进行了再植术。在这些患者中，输尿管大小在再植时显著减小。在 25 例患者中，有 4 例由于 2 例失访和 2 例随后行肾切除术而未进行再植术。21 例中有 2 例在非引流术后发生发热性 UTI。总平均随访时间为 34.2 个月（n=25），而非引流术后的平均随访时间为 41.5 个月（n=21）。没有发生吻合口并发症。
经皮输尿管造口术是治疗进展性原发性梗阻性巨输尿管的一种安全有效的临时手术。
