Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, SP, Brasil.
Int Braz J Urol. 2021 Jul-Aug;47(4):821-826. doi: 10.1590/S1677-5538.IBJU.2020.0686.
Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction (megaureter, ureterocele or ectopic ureter) and/or vesicoureteral reflux. Upper-pole nephrectomy is a widely accepted procedure to correct symptomatic duplex systems with poor functioning moieties, also known as upper or proximal approach. The distal ureteral stump syndrome (DUSS) can be a late complication of this approach. There is no consensus upon the length of ureteral dissection and the better approach to symptomatic disease in duplex systems, so we aim to identify if extended ureteral dissection can prevent DUSS in top-down approach.
Forty-four consecutive patients with symptomatic duplex system were retrospectively classified into two groups: those with limited ureteral excision after heminephrectomy (HN) (group-1) and those with extended ureterectomy after HN (group-2). Patients were followed-up for at least 36 months regarding outcomes of distal ureteral stump.
Overall complication was 20%. A total of 8 patients required unplanned further surgery in Group-1 (30%) whereas only 1 patient required unplanned surgery in group 2 (6%) (p=0.07). Subgroup analysis showed that Group-1 presented more DUSS requiring surgery during follow-up than group-2 (p=0.04). Factors possibly affecting complications incidence (such as ureterocele or ectopic ureter) did not differ between groups (p=0.72 and p=0.78).
Upper pole nephrectomy should be performed with extended distal ureteral dissection to prevent ureteral stump complications.
有症状的重复肾通常由于输尿管梗阻（巨输尿管、输尿管囊肿或异位输尿管）和/或膀胱输尿管反流而出现复发性尿路感染。上极肾切除术是一种广泛接受的纠正功能不佳部分的有症状重复系统的方法，也称为上极或近端方法。远端输尿管残端综合征（DUSS）可能是这种方法的晚期并发症。对于重复系统中输尿管解剖的长度和有症状疾病的更好方法，尚无共识，因此我们旨在确定自上而下的方法中是否可以通过延长输尿管解剖来预防 DUSS。
44 例有症状的重复系统患者被回顾性分为两组：肾部分切除术后行有限输尿管切除（HN）的患者（组 1）和 HN 后行广泛输尿管切除的患者（组 2）。患者至少随访 36 个月，观察远端输尿管残端的结果。
总并发症发生率为 20%。共有 8 例患者在组 1 中需要计划外进一步手术（30%），而在组 2 中仅 1 例患者需要计划外手术（6%）（p=0.07）。亚组分析显示，组 1 在随访期间需要手术的 DUSS 比组 2 更多（p=0.04）。可能影响并发症发生率的因素（如输尿管囊肿或异位输尿管）在两组之间没有差异（p=0.72 和 p=0.78）。
上极肾切除术应行广泛的远端输尿管解剖，以预防输尿管残端并发症。
