Jank Marietta, Stein Raimund, Younsi Nina
Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
Department of Pediatric Surgery, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
Front Pediatr. 2021 Apr 14;9:635950. doi: 10.3389/fped.2021.635950. eCollection 2021.
Congenital lower urinary tract obstruction (cLUTO) includes a heterogeneous group of conditions caused by a functional or mechanical outlet obstruction. Early vesicoamniotic shunting (VAS) possibly reduces the burden of renal impairment. Postpartum, pediatric urologists are confronted with neonates who have a shunt in place and a potentially impassable urethra with a narrow caliber. Early management of these patients can be challenging. Here, we would like to share the approach we have developed over time. We conducted a single-center retrospective analysis from 2016 to 2020 and included all patients diagnosed with cLUTO. Data focusing on time point and type of intervention was collected. Furthermore, patients with temporary diversion via a percutaneous VAS were selected for a more detailed review. In total, 71 cases of cLUTO were identified during the study period. Within this group, 31 neonates received postnatal management and surgical intervention in our center. VAS was performed in 55% of these cases ( = 17). The postnatal treatment varied between transurethral or suprapubic catheterization and early Blocksom vesicostomy. In five infants with VAS, the urinary drainage was secured through the existing VAS by inserting a gastric tube ( = 1) or a 4.8 Fr JJ-stent ( = 4). To our knowledge, this is the first report of a stent-in-stent scheme, which can remain indwelling until the definite treatment. Having a secure urine drainage through a VAS allows the often premature infant to grow until definite surgery can be performed. This avoids placing a vesicostomy, which requires anesthesia.
先天性下尿路梗阻（cLUTO）包括由功能性或机械性出口梗阻引起的一组异质性疾病。早期羊膜腔分流术（VAS）可能会减轻肾功能损害的负担。产后，小儿泌尿科医生会面对那些体内有分流装置且尿道口径狭窄可能无法通过的新生儿。对这些患者进行早期管理可能具有挑战性。在此，我们想分享我们长期以来形成的治疗方法。我们对2016年至2020年进行了单中心回顾性分析，纳入了所有诊断为cLUTO的患者。收集了关于干预时间点和类型的数据。此外，选择了通过经皮VAS进行临时引流的患者进行更详细的审查。在研究期间共确定了71例cLUTO病例。在这组病例中，有31例新生儿在我们中心接受了产后管理和手术干预。其中55%（n = 17）的病例进行了VAS。产后治疗包括经尿道或耻骨上膀胱造瘘术以及早期布洛克斯姆膀胱造口术。在5例接受VAS的婴儿中，通过插入胃管（n = 1）或4.8 Fr JJ支架（n = 4），通过现有的VAS确保了尿液引流。据我们所知，这是关于支架内置入方案的首次报告，该方案可以留置直到确定治疗方案。通过VAS实现安全的尿液引流可使通常早产的婴儿成长，直到能够进行确定性手术。这避免了进行需要麻醉的膀胱造口术。
