Vidal V, Fremond B, Chapuis M, Babut J M
Clinique Chirurgicale Infantile, Hôpital Pontchaillou, Rennes.
J Urol (Paris). 1988;94(5-6):279-83.
The authors analyse 24 cases of primary obstructive megaureter diagnosed before the age of 3 months. 18 were discovered by antenatal echography between 28 and 39 weeks, whereas 6 were detected by the occurrence of early urinary tract infection. Initial investigations included echography, intravenous urography and micturating cystouretrogram. Primary megaureter was bilateral in 14 cases, unilateral in 12. According to the urographic classification of Beurton, there were 12 ureters stage III, 12 stage II, 10 stage I. 15 patients were operated, 4 of them during the first months (2 reimplantations, 2 urinary diversions). 12 were submitted to later reimplantation at the mean age of 15 months, one had a non functioning kidney removed. 9 were non operated and treated conservatively by antibacterials and regular supervision. Results analysis evaluated according to radiological stage and treatment showed that in more cases, surgery should be differed initially. Complete clinical and radiological resolution is possible even in severe obstructions. Antibacterial treatment beginning at birth favorises regression of dilated ureter. Thus reimplantation should be deferred undercover of regular biological and radiological survey. The age of 12 to 18 months is the most technically favorable time to ureteric reimplantation.
作者分析了24例3个月龄前诊断出的原发性梗阻性巨输尿管病例。18例是在孕28至39周期间通过产前超声检查发现的，而6例是因早期尿路感染的发生而被检测出。初始检查包括超声检查、静脉肾盂造影和排尿性膀胱尿道造影。原发性巨输尿管14例为双侧，12例为单侧。根据Beurton的尿路造影分类，有12条输尿管为III期，12条为II期，10条为I期。15例患者接受了手术，其中4例在最初几个月内进行手术（2例输尿管再植术，2例尿流改道术）。12例在平均15个月龄时接受了后期再植术，1例切除了无功能肾。9例未手术，采用抗菌药物和定期监测进行保守治疗。根据放射学分期和治疗方法进行的结果分析表明，在更多病例中，手术应最初推迟。即使在严重梗阻的情况下，完全的临床和放射学缓解也是可能的。从出生开始的抗菌治疗有利于扩张输尿管的消退。因此，在定期的生物学和放射学检查的掩护下，应推迟再植术。12至18个月龄是输尿管再植术在技术上最有利的时间。
