Anhui Provincial Children's Hospital, Anhui, China.
Int Urol Nephrol. 2023 Oct;55(10):2373-2379. doi: 10.1007/s11255-023-03694-y. Epub 2023 Jul 1.
The aims of this study were to analyze the clinical outcomes of treating duplex system ureteroceles with early endoscopic puncture decompression and to identify the risk factors related to outcomes to help guide future work.
We retrospectively reviewed the clinical records of patients with ureteroceles with duplex kidney that were treated with early endoscopic puncture decompression. Charts were reviewed for demographics, preoperative imaging, surgical indications, and follow-up data. Recurrent febrile urinary tract infections (fUTIs), de novo vesicoureteral reflux (VUR), persistent high-grade VUR, unrelieved hydroureteronephrosis, and the need for further intervention were considered unfavorable outcomes. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), type of ureterocele, ipsilateral VUR diagnosed before surgery, simultaneously upper-pole moiety (UM) and lower-pole moiety (LM) obstruction, the width of ureter affiliated to UM, and maximum diameter of ureterocele were all considered potential risk factors. A binary logistic regression model was used to identify the risk factors of unfavorable outcomes.
A total of 36 patients with ureteroceles related to duplex kidney underwent endoscopic holmium laser puncture from 2015 to 2023 at our institution. After a median follow-up of 21.6 months, unfavorable outcomes developed in 17 patients (47.2%). Three patients underwent ipsilateral common-sheath ureter reimplantation and one patient underwent laparoscopic ipsilateral upper to lower ureteroureterostomy combined with recipient ureter reimplantation. Three patients underwent laparoscopic upper-pole nephrectomy. Fifteen patients suffered from recurrent UTIs were treated with oral antibiotics and eight of them were diagnosed de novo VUR according to voiding cystourethrography (VCUG). In univariate analysis, patients with simultaneously UM and LM obstruction (P = 0.003), fUTIs before surgery (P = 0.044), and ectopic ureterocele (P = 0.031) were more likely to have unfavorable outcomes. Binary logistic regression analysis showed that ectopic ureterocele (OR = 10.793, 95% CI 1.248-93.312, P = 0.031) and simultaneously UM and LM obstruction (OR = 8.304, 95% CI 1.311-52.589, P = 0.025) were identified as independent factors for unfavorable outcomes.
Our study suggested that early endoscopic puncture decompression is not a preferred but an available treatment option to release BOO or to cure refractory UTIs. It was easier to fail if the ureterocele was ectopic or simultaneously UM and LM obstruction existed. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), ipsilateral VUR diagnosed before surgery, the width of ureter affiliated to UM, and maximum diameter of ureterocele were not significantly related to the success rate of early endoscopic punctures.
本研究旨在分析早期内镜穿刺减压治疗双肾盂输尿管囊肿的临床效果，并确定与治疗效果相关的风险因素，以指导未来的工作。
我们回顾性分析了 36 例接受早期内镜穿刺减压治疗的双肾盂输尿管囊肿患者的临床资料。回顾了患者的人口统计学、术前影像学、手术适应证和随访数据。复发性发热性尿路感染（fUTI）、新发膀胱输尿管反流（VUR）、持续性重度 VUR、未缓解的肾盂积水和需要进一步干预被认为是不良结局。性别、手术时的年龄、BMI、产前诊断、fUTI、膀胱出口梗阻（BOO）、输尿管囊肿类型、术前同侧 VUR 诊断、同侧上极段（UM）和下极段（LM）同时梗阻、与 UM 相关的输尿管宽度和输尿管囊肿的最大直径均被认为是潜在的风险因素。使用二元逻辑回归模型确定不良结局的风险因素。
本研究共纳入 36 例双肾盂输尿管囊肿患者，于 2015 年至 2023 年在我院行内镜钬激光穿刺治疗。中位随访 21.6 个月后，17 例（47.2%）患者出现不良结局。3 例患者行同侧共同鞘输尿管再植入术，1 例患者行腹腔镜同侧上极至下极输尿管肾盂成形术联合受者输尿管再植入术。3 例患者行腹腔镜上极切除术。15 例复发性尿路感染患者接受口服抗生素治疗，其中 8 例根据排尿性膀胱尿道造影（VCUG）诊断为新发 VUR。单因素分析显示，同时存在 UM 和 LM 梗阻（P=0.003）、术前存在 fUTI（P=0.044）和异位输尿管囊肿（P=0.031）的患者更有可能出现不良结局。二元逻辑回归分析显示，异位输尿管囊肿（OR=10.793，95%CI 1.248-93.312，P=0.031）和同时存在 UM 和 LM 梗阻（OR=8.304，95%CI 1.311-52.589，P=0.025）是不良结局的独立危险因素。
本研究表明，早期内镜穿刺减压不是首选治疗方法，但可用于解除 BOO 或治疗难治性尿路感染。如果输尿管囊肿为异位或同时存在 UM 和 LM 梗阻，治疗效果更差。性别、手术时的年龄、BMI、产前诊断、fUTI、BOO、术前同侧 VUR 诊断、与 UM 相关的输尿管宽度和输尿管囊肿的最大直径与早期内镜穿刺的成功率无显著相关性。
