Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Urol. 2021 Jun;205(6):1792-1797. doi: 10.1097/JU.0000000000001591. Epub 2021 Feb 3.
Primary valve ablation is preferred to vesicostomy in the initial management of posterior urethral valves. However, some neonates have a prohibitively small urethra. We describe our experience with a preoperative urethral catheter regimen to enhance the likelihood of neonatal valve ablation.
We performed a retrospective review of 126 neonates with posterior urethral valves treated between 2003 and 2019 with valve ablation prior to 10 weeks of age. The preoperative indwelling catheter either was gradually upsized to an 8Fr (progressive urethral dilation), was not upsized (nondilated) or was initially larger bore (8Fr only). The primary outcome was the ability to perform primary ablation by neonatal resectoscope. The secondary objective was to establish the parameters for considering progressive urethral dilation as well as its associated risks.
Overall 97% could be ablated. The progressive urethral dilation group had the lowest mean weight (p <0.001). Only a larger catheter at the time of ablation was significantly associated with feasible ablation (p <0.001) and not urethral dilation, the infant's weight or his gestational age. Progressive urethral dilation was associated with a longer duration of catheterization as well as double the rate of febrile urinary tract infections (8.5%) over the nondilated group (3.6%).
A much higher rate of primary ablation is feasible (97%) than previously reported (82%). More important than the infant's weight is whether a 6Fr to 8Fr catheter is in place at ablation. If an initial 6Fr to 8Fr catheter cannot be placed, urethral dilation to 8Fr should be performed before attempting ablation. This is both a technique and preoperative assessment that is useful for operative planning.
在处理后尿道瓣膜时，首选原发性瓣膜消融术而非膀胱造口术。然而，一些新生儿的尿道非常小。我们描述了一种术前尿道导管方案，以提高新生儿瓣膜消融术的可能性。
我们回顾性分析了 2003 年至 2019 年间 126 例接受后尿道瓣膜治疗的新生儿，这些新生儿在 10 周龄之前接受了瓣膜消融术。术前留置的导管要么逐渐增大到 8Fr（尿道扩张），要么不增大（未扩张），要么初始直径较大（仅 8Fr）。主要结果是通过新生儿电切镜进行原发性消融的能力。次要目标是确定考虑尿道扩张的参数及其相关风险。
总体上 97%的患儿可以进行消融。尿道扩张组的平均体重最低（p<0.001）。只有在消融时使用更大的导管与可行的消融显著相关（p<0.001），而与尿道扩张、婴儿体重或胎龄无关。尿道扩张与更长的导管留置时间以及发热性尿路感染的发生率增加一倍（扩张组为 8.5%，未扩张组为 3.6%）相关。
比之前报道的（82%）更高的原发性消融成功率（97%）是可行的。比婴儿体重更重要的是在消融时是否有 6Fr 到 8Fr 的导管。如果初始 6Fr 到 8Fr 的导管无法放置，则应在尝试消融前进行尿道扩张至 8Fr。这是一种术前评估和技术，对于手术计划非常有用。
