Bomalaski M D, Ritchey M L, Bloom D A
Section of Pediatric Urology, University of Michigan, Ann Arbor, USA.
J Urol. 1997 Sep;158(3 Pt 2):1226-8. doi: 10.1097/00005392-199709000-00144.
After ureteroneocystostomy we have performed renal ultrasonography within the first 3 months to exclude hydronephrosis, voiding cystography after 3 months to exclude vesicoureteral reflux and subsequent ultrasonography to monitor the upper tracts. This study attempted to determine those patients at risk for hydronephrosis or recurrent vesicoureteral reflux.
We studied the records of patients who underwent ureteroneocystostomy in the last decade at our institutions to find the incidence and degree of preoperative and postoperative hydronephrosis and vesicoureteral reflux. Results of initial postoperative imaging were compared to radiological imaging throughout followup (mean 2.3 years). Patients with postoperative reflux were evaluated for risk factors that differentiated them from others.
Excluding patients with neuropathic bladder or ureterocele, 167 underwent 278 ureteroneocystostomies at a mean followup of 26.5 months. Persistent vesicoureteral reflux was noted in 4 kidneys (1.4%) and contralateral reflux developed in 3 of the 48 cases (6.3%) of unilateral ureteroneocystostomy. There was no statistical difference in success rates among cross-trigonal, ureteral advancement or extravesical techniques. New onset mild hydronephrosis in 13 kidneys (4.7%) at the initial followup study (mean 1.6 months) completely resolved in 12 and remained mild in 1. No patient had progression of existing hydronephrosis and 1 had recurrent vesicoureteral reflux after initial negative cystography. Risk factors for postoperative reflux or hydronephrosis were preoperative dysfunctional voiding, preoperative hydronephrosis or scarring on sonography and postoperative urinary tract infection. None of the 88 patients without these risk factors had postoperative hydronephrosis or reflux. All patients with persistent, contralateral or recurrent reflux were selected using these criteria (p < 0.003).
Complication rates after nontapered ureteroneocystostomy in children without neuropathic bladder are quite low. Mild postoperative hydronephrosis was not clinically significant in our patients. Children with abnormal preoperative ultrasound or dysfunctional voiding are identified as a high risk group for postoperative hydronephrosis or recurrent reflux. All other patients received little benefit from postoperative imaging, suggesting that further evaluation of this group is necessary only in the presence of a postoperative urinary tract infection.
在输尿管膀胱再植术后的前3个月内，我们进行肾脏超声检查以排除肾积水；3个月后进行排尿性膀胱造影以排除膀胱输尿管反流，并随后进行超声检查以监测上尿路情况。本研究试图确定那些有肾积水或复发性膀胱输尿管反流风险的患者。
我们研究了过去十年在我们机构接受输尿管膀胱再植术患者的记录，以找出术前和术后肾积水及膀胱输尿管反流的发生率和程度。将术后初次影像学检查结果与整个随访期间（平均2.3年）的放射学影像进行比较。对术后发生反流的患者评估使其与其他患者相区别的危险因素。
排除神经源性膀胱或输尿管囊肿患者后，167例患者接受了278次输尿管膀胱再植术，平均随访26.5个月。4个肾脏（1.4%）出现持续性膀胱输尿管反流，48例单侧输尿管膀胱再植术中3例（6.3%）出现对侧反流。三角区交叉、输尿管推进或膀胱外技术的成功率无统计学差异。在初次随访研究（平均1.6个月）时，13个肾脏（4.7%）出现新发轻度肾积水，其中12个完全缓解，1个仍为轻度。没有患者原有肾积水进展，1例在初次膀胱造影阴性后出现复发性膀胱输尿管反流。术后反流或肾积水的危险因素为术前排尿功能障碍、术前肾积水或超声检查发现瘢痕以及术后尿路感染。88例无这些危险因素的患者均未出现术后肾积水或反流。所有持续性、对侧或复发性反流患者均根据这些标准选出（p < 0.003）。
在无神经源性膀胱的儿童中，非锥形输尿管膀胱再植术后的并发症发生率相当低。在我们的患者中，术后轻度肾积水无临床意义。术前超声异常或排尿功能障碍的儿童被确定为术后肾积水或复发性反流的高危人群。所有其他患者从术后影像学检查中获益甚微，这表明仅在出现术后尿路感染时才需要对该组患者进行进一步评估。
