Cukier J, Magnier M, Szemat R, Pascal B, Beurton D
J Urol (Paris). 1983;89(9):629-34.
The authors report their experience gained from a series of 82 cases of severe posterior urethral valves with distension of the upper urinary tract. From analysis of their own series and from a study of the literature, they propose a therapeutic approach to these severe forms. Vesico-ureteral reflux was present in 45% of cases. Once the patency of the bladder neck and urethra was restored, 41% of these cases of reflux disappeared spontaneously and 25% persisted but were well tolerated. Only 13 ureters (29.5%) had to be re-implanted. The cases of ureteral distension without reflux had a similar favourable course after removal of the obstruction of the lower urinary tract. 57% of the dilated ureters resolved or were greatly improved and 11% persisted but were well tolerated. Simple treatment of the valves meant that ureterovesical re-implantation was avoided in 68% of cases. The overall results of uretero-vesical re-implantation were mediocre: out of 32 re-implanted ureters, there were only 15 successes (46.9%), 13 cases (40.6%) were unchanged and there were 4 failures (12.5%). The authors recommend the simple treatment of the posterior valves and suggest careful consideration of the indications for ureterovesical re-implantations in children with abnormal bladder and ureters proximal to the posterior urethral valves.
作者报告了他们从82例伴有上尿路扩张的重度后尿道瓣膜症病例中获得的经验。通过对自身病例系列的分析以及对文献的研究，他们提出了针对这些严重病例的治疗方法。45%的病例存在膀胱输尿管反流。一旦膀胱颈和尿道恢复通畅，这些反流病例中有41%会自发消失，25%的反流持续存在但耐受性良好。仅13条输尿管（29.5%）需要重新植入。在下尿路梗阻解除后，无反流的输尿管扩张病例也有类似的良好转归。57%的扩张输尿管恢复正常或明显改善，11%持续存在但耐受性良好。瓣膜的简单治疗意味着68%的病例避免了输尿管膀胱重新植入。输尿管膀胱重新植入的总体效果一般：在32条重新植入的输尿管中，仅有15例成功（46.9%），13例（40.6%）无变化，4例失败（12.5%）。作者推荐对后尿道瓣膜进行简单治疗，并建议在患有后尿道瓣膜近端膀胱和输尿管异常的儿童中，仔细考虑输尿管膀胱重新植入的指征。
