Yin Xiaoming, Yang Yi
Department of Pediatric Urology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning province 110004, China.
Department of Pediatric Urology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning province 110004, China.
J Pediatr Urol. 2023 Feb;19(1):88.e1-88.e8. doi: 10.1016/j.jpurol.2022.10.022. Epub 2022 Oct 19.
Ectopic ureterocele management in children remains a controversial subject without a clear consensus. The purpose of this study was to explore the risk factors for adverse outcomes and secondary surgery in pediatric patients with unilateral ectopic duplex system ureterocele, a complex urinary system deformity with controversial treatment.
We retrospectively reviewed 75 patients with unilateral ectopic duplex system ureterocele who underwent surgery at the Shengjing Hospital of China Medical University between January 1, 2008, and September 31, 2020. Demographic characteristics, preoperative data, surgical procedures, postoperative adverse outcomes, and secondary surgery were recorded. Adverse outcomes were defined as new-onset VUR and BOO after surgery. The risks of adverse outcomes and secondary surgery were evaluated using multivariate binary logistic regression and expressed as adjusted odds ratios with 95% confidence intervals.
Adverse outcomes occurred in 25 (33.3%) patients, including 24 (32.0%) with new-onset vesicoureteral reflux and 1 (1.3%) with bladder outlet obstruction. Seven (9.3%) patients required secondary surgery. The independent risk factors for adverse outcomes were transurethral endoscopic incision and transurethral endoscopic puncture (transurethral endoscopic incision vs. upper pole partial nephrectomy: OR = 11.049, P = 0.004; transurethral endoscopic puncture vs. upper pole partial nephrectomy: OR = 33.222, P = 0.002).
The definitive treatment for duplex system ureterocele remains controversial. We found that transurethral endoscopic incision or puncture was an independent risk factor for adverse outcomes. The main limitation of this study would be its retrospective nature and relatively short follow-up period. Furthermore, 30 children were younger than 5 years at last follow up, and thus, we could not efficiently evaluate their voiding function.
Transurethral endoscopic incision or puncture is effective for decompressing the obstruction of the upper urinary tract in acute urosepsis in ectopic duplex system ureterocele. Although more than half of patients with unilateral ectopic duplex system ureterocele suffered from new-onset vesicoureteral reflux after transurethral endoscopic incision or puncture, few of them required secondary surgery.
儿童异位输尿管囊肿的治疗仍是一个存在争议的话题，尚未达成明确共识。本研究旨在探讨单侧异位重复系统输尿管囊肿（一种治疗存在争议的复杂泌尿系统畸形）患儿出现不良结局及二次手术的危险因素。
我们回顾性分析了2008年1月1日至2020年9月31日在中国医科大学附属盛京医院接受手术的75例单侧异位重复系统输尿管囊肿患儿。记录人口统计学特征、术前数据、手术方式、术后不良结局及二次手术情况。不良结局定义为术后新发膀胱输尿管反流（VUR）和膀胱出口梗阻（BOO）。采用多因素二元逻辑回归评估不良结局和二次手术的风险，并以调整后的比值比及95%置信区间表示。
25例（33.3%）患儿出现不良结局，其中24例（32.0%）新发膀胱输尿管反流，1例（1.3%）出现膀胱出口梗阻。7例（9.3%）患儿需要二次手术。不良结局的独立危险因素为经尿道内镜切开术和经尿道内镜穿刺术（经尿道内镜切开术与上极部分肾切除术相比：OR = 11.049，P = 0.004；经尿道内镜穿刺术与上极部分肾切除术相比：OR = 33.222，P = 0.002）。
重复系统输尿管囊肿的确定性治疗仍存在争议。我们发现经尿道内镜切开术或穿刺术是不良结局的独立危险因素。本研究的主要局限性在于其回顾性研究性质及随访时间相对较短。此外，最后一次随访时30例患儿年龄小于5岁，因此我们无法有效评估其排尿功能。
经尿道内镜切开术或穿刺术对于缓解异位重复系统输尿管囊肿急性尿脓毒症时上尿路梗阻有效。尽管超过一半的单侧异位重复系统输尿管囊肿患儿在经尿道内镜切开术或穿刺术后出现新发膀胱输尿管反流，但其中很少有人需要二次手术。
