McCool A C, Pérez L M, Joseph D B
Division of Urology, University of Alabama at Birmingham, Children's Hospital 35233, USA.
J Urol. 1997 Sep;158(3 Pt 2):1219-20. doi: 10.1097/00005392-199709000-00142.
We reviewed our experience with contralateral vesicoureteral reflux following unilateral ureteroneocystostomy.
We retrospectively identified 88 children who underwent unilateral ureteroneocystostomy from 1986 through 1995, including standard repair in 69 and tapered repair in 19. Cystoscopy was performed in all cases immediately before repair.
Grades IV to V vesicoureteral reflux was identified preoperatively in 34% of the patients, including 13 (19%) and 14 (74%) who underwent standard and tapered repair, respectively. Renal duplication was noted in 24% of the cases, including 18 standard (26%) and 3 tapered (16%) repairs. An abnormal contralateral nonrefluxing ureteral orifice was present in 8 of the 53 standard (15%) and 3 of the 14 (21%) tapered cases. Ipsilateral reflux was corrected in all children undergoing standard repair but it persisted in 4 (21%) in the tapered repair group. Postoperatively contralateral vesicoureteral reflux developed in 1 child (1.4%) in the standard and 1 (5.3%) in the tapered repair group.
Contralateral vesicoureteral reflux is rare and does not appear to be influenced by preoperative reflux grade, a duplicated system or the endoscopic appearance of the ureteral orifice.
我们回顾了单侧输尿管膀胱吻合术后对侧膀胱输尿管反流的治疗经验。
我们回顾性分析了1986年至1995年间接受单侧输尿管膀胱吻合术的88例患儿，其中69例行标准修复术，19例行锥形修复术。所有病例在修复前均立即进行膀胱镜检查。
术前34%的患者发现IV至V级膀胱输尿管反流，其中分别有13例（19%）和14例（74%）接受标准修复术和锥形修复术。24%的病例发现有重复肾，其中标准修复术组18例（26%），锥形修复术组3例（16%）。在53例标准修复术病例中有8例（15%）、14例锥形修复术病例中有3例（21%）存在对侧非反流性输尿管口异常。所有接受标准修复术的患儿同侧反流均得到纠正，但锥形修复术组有4例（21%）仍存在反流。标准修复术组术后有1例患儿（1.4%）、锥形修复术组有1例患儿（约5.3%）出现对侧膀胱输尿管反流。
对侧膀胱输尿管反流很少见，且似乎不受术前反流分级、重复肾系统或输尿管口内镜表现的影响。
