Caione Paolo, Gerocarni Nappo Simona, Collura Giuseppe, Matarazzo Ennio, Bada Maida, Del Prete Laura, Innocenzi Michele, Mele Ermelinda, Capozza Nicola
Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
Front Pediatr. 2019 Apr 8;7:106. doi: 10.3389/fped.2019.00106. eCollection 2019.
Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy. Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5-0.8 joule energy, through 8-9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18-24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6-18 months in selected cases. Statistical analysis was utilized for data evaluation. From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1-168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6-18 months follow-up for recurrent dilatation. Urinary tract infections and refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls ( < . Further surgery was required in 12 patients (18%) at 1-5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group ( < . Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery.
输尿管囊肿可导致婴幼儿和儿童严重的肾盂输尿管梗阻并伴有无热性尿路感染。提倡早期减压治疗以降低相关肾和尿路损伤的风险。已采用透热电极提供内镜下切开技术。我们采用激光能量来解除输尿管囊肿的梗阻并减少进一步手术的需求。我们描述了我们的技术并展示了结果，并与一组接受透热能量治疗的匹配患者进行了比较。在输尿管囊肿底部通过内镜多点穿刺进行减压。在全身麻醉下，通过8 - 9.8F膀胱镜使用钬激光，能量为0.5 - 0.8焦耳。对照组通过小儿复位膀胱镜使用透热能量进行输尿管囊肿切开。18 - 24小时后拔除 Foley 留置导尿管。在随访的1、3、6和12个月时进行肾脏超声检查。在选定病例中，在6 - 18个月时进行排尿性膀胱尿道造影和放射性核素肾扫描。采用统计分析进行数据评估。2012年1月至2017年12月，共进行了64例内镜手术：49例为异位输尿管囊肿，15例为正位输尿管囊肿。53例为重复肾系统，大多为异位输尿管囊肿。内镜检查时的平均年龄为6.3个月（1 - 168个月）。输尿管囊肿立即得到减压，但在5例（8%）患者中，在随访6 - 18个月时因复发扩张需要进行第二次内镜穿刺。研究组中尿路感染和反流的发生率分别为23.4%和29.7%，而26例对照组分别为38.5%和61.5%（P<...）。在1 - 5年的随访中，12例患者（18%）需要进一步手术（10例为重复肾系统的异位输尿管囊肿患者）：7例因反流进行输尿管再植术，5例进行腹腔镜半肾输尿管切除术。正位输尿管囊肿的预后较好。对照组13例患者（50.0%）需要二次手术（P<...）。早期内镜减压应被视为婴幼儿和儿童梗阻性输尿管囊肿的一线治疗方法。在输尿管囊肿底部进行多点穿刺，采用低激光能量，是一种真正的微创治疗方法，可立即对上尿路进行减压，并降低进一步进行侵袭性手术的风险。
