Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
Int Urol Nephrol. 2024 Nov;56(11):3495-3502. doi: 10.1007/s11255-024-04108-3. Epub 2024 Jun 11.
To compare efficacy of proximal and distal laparoscopic ureteroureterostomy (UU) for complete duplex kidneys in children.
Patients who underwent laparoscopic UU for complete duplex kidneys between December 2016 and July 2022 were reviewed retrospectively. 71 patients who had normal lower pole moiety without vesicoureteral reflux (VUR) were recruited. All of them underwent ultrasound, voiding cystourethrography (VCUG), renal scintigraphy, and magnetic resonance urography preoperatively. Proximal laparoscopic UU was performed in 35 patients and distal laparoscopic UU in 36 patients. Double J stents were placed in normal lower pole moieties. Clinical data, including general information, diagnosis, surgical management, imaging characteristics, clinical symptoms and postoperative complications (classified according to the modified Clavien-Dindo classification), and length of stay were recorded. Measurement date comparisons between groups were performed by t test, counting date were analyzed by chi-square test.
The study consisted of 71 patients (56 females and 15 males) with complete duplex kidneys (41 in left kidney and 30 in right kidney). The patients' mean age was 34 m (range 3-161 m) and follow-up ranged from 25 to 81 m. No significant difference was found in age and follow-up time between the two groups. Laparoscopic UU was performed in all patients successfully. The operation time of the two groups was 108.42 ± 26.95 min for distal UU vs 121.46 ± 35.15 min for proximal UU(p = 0.14). No significant difference in postoperative complications was seen between the two groups (22.2% vs 31.4%, p = 0.345). However, in terms of the grading of postoperative complications, the proximal UU group had a higher grade (3 of them had a grade of IV) and more serious complications.
There was no significant difference in the overall incidence of complications between distal and proximal UU. Compared with proximal laparoscopic UU, distal laparoscopic UU is easier to perform with less injury to the peripheral tissues. Postoperative complications of proximal UU are more serious and more difficult to manage. We recommend complete duplex kidney ureteral reconstruction with distal UU.
比较近端和远端腹腔镜输尿管-输尿管吻合术（UU）治疗完全性重复肾的疗效。
回顾性分析 2016 年 12 月至 2022 年 7 月间接受腹腔镜 UU 治疗完全性重复肾的患者。纳入无下极段反流（VUR）的正常下极段患者 71 例。所有患者术前均行超声、排尿性膀胱尿道造影（VCUG）、肾闪烁显像和磁共振尿路成像检查。35 例患者行近端腹腔镜 UU，36 例患者行远端腹腔镜 UU。正常下极段留置双 J 支架。记录临床资料，包括一般资料、诊断、手术管理、影像学特征、临床症状及术后并发症（按改良 Clavien-Dindo 分级），并记录住院时间。组间计量资料比较采用 t 检验，计数资料比较采用卡方检验。
本研究共纳入 71 例（女 56 例，男 15 例）完全性重复肾患者（左侧 41 例，右侧 30 例）。患者平均年龄 34 月龄（3161 月龄），随访时间 2581 月龄。两组患者年龄和随访时间比较差异无统计学意义。所有患者均成功完成腹腔镜 UU。远端 UU 组手术时间为 108.42±26.95min，近端 UU 组为 121.46±35.15min（p=0.14）。两组术后并发症发生率差异无统计学意义（22.2%比 31.4%，p=0.345）。但近端 UU 组术后并发症分级较高（3 例为 IV 级），并发症更严重。
远端和近端 UU 的总体并发症发生率无显著差异。与近端腹腔镜 UU 相比，远端腹腔镜 UU 更容易操作，对周围组织损伤更小。近端 UU 的术后并发症更严重，更难处理。我们建议对完全性重复肾行远端 UU 输尿管重建术。
