Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, School of Medicine, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, School of Medicine, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
J Pediatr Urol. 2023 Feb;19(1):87.e1-87.e6. doi: 10.1016/j.jpurol.2022.10.010. Epub 2022 Oct 12.
The best surgical approach to ectopic ureters and ureteroceles is yet to be determined. The objective of this study is to provide an alternative lower tract surgical approach to ectopic ureters and duplex system ureteroceles that can be safely performed in young children.
The "in-and-out" bladder approach was performed via an open intravesical incision. The upper and lower pole ureters were mobilized and brought into the bladder. The dilated ureter/ureterocele was cut open, and the distal part was deuroepithelialized. Subsequently, common sheath reimplantation was performed. The ureterocele wall was not involved during the whole procedure. We retrospectively reviewed all patients who underwent surgery for ureteroceles and ectopic ureters between January 1, 2004, and December 31, 2019. Patients with intravesical ureteroceles were excluded. Outcome parameters included the presence of hydronephrosis or reflux, split renal function on DMSA scan, incidence of urinary tract infection, and urinary incontinence.
A total of 32 patients with ectopic duplex system ureterocele who underwent the "in-and-out" bladder approach between 2004 and 2019 were included in the retrospective study. The median age at operation was 7.8 months (range: 1.5 months-3.0 years). The median length of follow-up was 6.1 years (range: 1.0 years-14.3 years). Sixteen patients (55%) had ipsilateral vesicoureteral reflux. Five patients postoperatively developed a urinary tract infection within 1-3 years. No patients required further endoscopic treatment or surgeries. During long-term follow-up, two patients (6.3%) had intermittent day wetting at the ages of 4 and 5 years and were managed conservatively. The symptoms of intermittent day wetting subsided during follow-up.
The "in-and-out bladder" approach can be performed in complex duplex system ureteroceles and enables early intervention; it is a single and simple operation with a satisfactory long-term continence rate.
异位输尿管和输尿管囊肿的最佳手术方法仍有待确定。本研究的目的是为异位输尿管和双输尿管系统输尿管囊肿提供一种替代的下尿路手术方法，以便在幼儿中安全实施。
采用开放式膀胱内切开术进行“进出”膀胱入路。将上下极输尿管游离并带入膀胱。扩张的输尿管/输尿管囊肿切开，远端去上皮化。随后进行共同鞘管再植入。整个过程中不涉及输尿管囊肿壁。我们回顾性分析了 2004 年 1 月 1 日至 2019 年 12 月 31 日期间因输尿管囊肿和异位输尿管接受手术的所有患者。排除膀胱内输尿管囊肿患者。观察指标包括是否存在肾积水或反流、DMSA 扫描时的分肾功能、尿路感染发生率和尿失禁。
共有 32 例接受 2004 年至 2019 年“进出”膀胱入路的异位双输尿管系统输尿管囊肿患者纳入回顾性研究。手术时的中位年龄为 7.8 个月（范围：1.5 个月-3.0 岁）。中位随访时间为 6.1 年（范围：1.0 年-14.3 年）。16 例患者（55%）有同侧输尿管反流。术后 5 例在 1-3 年内发生尿路感染。无患者需要进一步内镜治疗或手术。在长期随访中，2 名患者（6.3%）分别在 4 岁和 5 岁时出现间歇性日间遗尿，接受保守治疗。日间遗尿症状在随访期间缓解。
“进出膀胱”入路可用于复杂的双输尿管系统输尿管囊肿，并可进行早期干预；它是一种单一且简单的操作，具有令人满意的长期控尿率。
