N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation.
N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation.
J Pediatr Urol. 2022 Apr;18(2):224.e1-224.e8. doi: 10.1016/j.jpurol.2021.12.004. Epub 2021 Dec 11.
According to available data, there are only few articles describing pneumovesicoscopic (PNV) ureteral reimplantation (UR) for obstructive megaureter without tailoring and with ex vivo tailoring in children.
To present our experience of the PNV UR using intravesical ureteral tailoring for symptomatic primary obstructive megaureter in children.
Between 2014 and 2020, 42 patients (mean age: 3.1 years) underwent a correction of primary obstructive megaureter (POM) via a vesicoscopic approach. Nine of them with the megaureter (diameter > 25 mm) underwent the intravesical ureteral tailoring. The analysis included only 9 patients who underwent intravesical tailoring of the ureter using the original technique. The dilated ureter is fixed intravesical by the loop in extended position. This simplifies the tailoring step of the ureter. The tailoring is performed by continuous suture (Star).
43 UR were analyzed (1 bilateral, 1 with diverticulum, 1 with ureterocele). The mean operative time was 142 min (83-235 min). The mean manipulation time for intravesical tailoring of the megaureter was 18 min. After the surgery, the average kidney function doesn't reduce. We observed an increase in renal function by an average of 7% in three patients after the surgery. One patient required a conversion. It was in the early stages of mastering the technique. All patients underwent US 1-3 weeks 3-6-12 months after the operation, the size of the pelvic system and ureter decreased. Eight patients are asymptomatic, and only one has the clinical changes (a persistent leukocyturia, the size of the pelvic-ureteric segment, and the ureter remain unchanged or increased). According to the VCUG vesicoureteral reflux was detected in this case. An endoscopic correction used successful.
This possibility of applying our technique is confirmed according to folow-up data and should be used in other researches. The drainage of the ureter with an external stent for 1 month helps to form properly the neo-ureterovesical anastomosis and to prevent episodes of ureteral obstruction as a result the incidence of urinary tract infections reduces in the postoperative period.
The use of the Tuohy needle with the loop simplifies the fixation of the ureter. This helps to make the intravesical tailoring of the megaureter easier and faster. It is original and less traumatic for the ureter than existing methods.
根据现有数据，只有少数几篇文章描述了经皮膀胱镜（PNV）输尿管再植术（UR）治疗无裁剪和离体裁剪的梗阻性巨输尿管，且这些文章主要针对儿童。
介绍我们使用膀胱内输尿管裁剪术治疗儿童原发性梗阻性巨输尿管（POM）的经验。
2014 年至 2020 年期间，42 名患者（平均年龄 3.1 岁）接受了经膀胱入路治疗原发性梗阻性巨输尿管（POM）。其中 9 例巨输尿管（直径>25mm）接受了膀胱内输尿管裁剪术。该分析仅包括 9 例采用原始技术行膀胱内输尿管裁剪术的患者。扩张的输尿管在延长位置的环内固定于膀胱内。这简化了输尿管裁剪步骤。裁剪通过连续缝合（Star）进行。
分析了 43 例 UR（1 例双侧，1 例合并憩室，1 例合并输尿管囊肿）。平均手术时间为 142 分钟（83-235 分钟）。膀胱内裁剪巨输尿管的平均操作时间为 18 分钟。手术后，平均肾功能无下降。手术后，3 名患者的肾功能平均增加了 7%。1 例患者需要转换。这是在掌握技术的早期阶段。所有患者术后 1-3 周、3-6-12 个月进行 US 检查，肾盂系统和输尿管的大小均减小。8 例患者无症状，仅 1 例出现临床改变（持续白细胞尿，肾盂输尿管段大小及输尿管无变化或增大）。该病例中，根据 VCUG 检查发现存在膀胱输尿管反流。采用内镜矫正成功。
根据随访数据证实了应用我们技术的可能性，应在其他研究中使用。输尿管外支架引流 1 个月有助于适当形成新的输尿管膀胱吻合口，并防止输尿管梗阻发作，从而降低术后尿路感染的发生率。
使用 Tuohy 针和环简化了输尿管的固定。这有助于使膀胱内巨输尿管裁剪更容易和更快。与现有的方法相比，它对输尿管的创伤更小。
