Carol Davila University of Medicine and Pharmacy, Bucharest.
Department of Pediatric Surgery and Urology, Maria Sklodowska Curie Emergency Children Hospital, Bucharest.
Pediatr Med Chir. 2023 Dec 19;45(2). doi: 10.4081/pmc.2023.327.
The megaureter accounts for almost a quarter of all urinary tract dilations diagnosed in utero and is the second leading cause of hydronephrosis in newborns, following pyeloureteral junction obstruction. The current standard treatment for progressive or persistent, symptomatic primary obstructive megaureter is ureteral anti-reflux reimplantation, which can be associated with ureteral remodeling or plication. Due to the associated morbidity, postoperative recovery challenges, and the complications that may arise from the open surgical approach, there has been a natural inclination towards validating new minimally invasive techniques. This study reviews the literature, extracting data from three major international databases, from 1998 to 2022. Out of 1172 initially identified articles, only 52 were deemed eligible, analyzing 1764 patients and 1981 renal units. Results show that 65% of cases required surgical intervention, with minimally invasive techniques constituting 56% of these procedures. High-pressure endoscopic balloon dilation was the preferred endourologic technique. The degree of ureterohydronephrosis is considered one of the factors indicating the need for surgery. There is an inverse relationship between the diameter of the ureter and the likelihood of spontaneous resolution. Conditions such as renal hypoplasia, renal dysplasia, or ectopic ureteral insertion strongly indicate a poor prognosis. Endoscopic surgical techniques for treating primary obstructive megaureter can be definitive, firstline treatment options. In selected cases, they might be at least as effective and safe as the open approach, but with advantages like quicker recovery, fewer complications, shorter hospital stays, and reduced costs.
巨输尿管占所有产前诊断的尿路扩张的近四分之一，是继肾盂输尿管交界处梗阻后导致新生儿肾积水的第二大主要原因。对于进行性或持续性、有症状的原发性梗阻性巨输尿管，目前的标准治疗方法是抗反流输尿管再植入术，该手术可伴有输尿管重塑或折叠。由于相关的发病率、术后恢复挑战以及开放手术方法可能出现的并发症，人们自然倾向于验证新的微创技术。本研究回顾了文献，从 1998 年到 2022 年，从三个主要国际数据库中提取数据。在最初确定的 1172 篇文章中，只有 52 篇被认为符合条件，分析了 1764 例患者和 1981 个肾脏单位。结果表明，65%的病例需要手术干预，微创技术构成这些手术的 56%。高压内镜球囊扩张是首选的腔内泌尿外科技术。输尿管积水的程度被认为是需要手术的因素之一。输尿管直径与自发性缓解的可能性呈反比。肾发育不全、肾发育不良或异位输尿管插入等情况预示着预后不良。治疗原发性梗阻性巨输尿管的内镜手术技术可以作为确定性的一线治疗选择。在某些情况下，它们至少与开放方法一样有效和安全，但具有恢复更快、并发症更少、住院时间更短和成本降低等优点。
