Dahm P, King L R
Department of General Surgery, Division of Urology, Duke University Medical Center, Durham, N.C., USA.
Urol Int. 1998;61(3):157-61. doi: 10.1159/000030313.
The value of primary transurethral ureterocele incision was investigated in the treatment of ureteroceles in infants and children.
The charts and radiographic studies of 13 patients between the ages of 2 weeks and 8 years who underwent transurethral incision of 14 ureteroceles as primary surgical therapy at our institution were reviewed.
57% of the ureteroceles were intravesical and 43% extravesical. 64.3% were associated with the upper pole of a duplicated system. All 14 ureteroceles were associated with a functional renal moiety. Endoscopic incision achieved ureterocele decompression in 13 of 14 ureteroceles (93%). Preexisting hydronephrosis improved or resolved in 10 of 14 cases (71.4%). Renal function after decompression was not shown to be significantly altered or improved. 5 of 13 patients (38%) required definite surgical reconstruction for recurrent urinary tract infections, upper pole vesicoureteral reflux, hydronephrosis and lower pole vesicoureteral reflux within a mean follow-up period of 14 months.
Transurethral incision has a limited role in the treatment of ureteroceles in children. In many or even most cases it cannot be expected to constitute long-term definite treatment for ureteroceles. It is mainly indicated in patients with urosepsis, prolapsing ureteroceles with functional bladder neck obstruction or massive reflux into other renal segments. In these settings it reliably achieves decompression and allows effective treatment of infection. The function of the previously obstructed renal segment can be reevaluated at later point in time to assess whether it should be saved. The delay permits interim growth that is likely to make bladder reconstruction easier.
探讨一期经尿道输尿管囊肿切开术治疗婴幼儿输尿管囊肿的价值。
回顾性分析我院13例年龄在2周龄至8岁之间的患儿病历及影像学资料，这些患儿接受了14例输尿管囊肿一期经尿道切开手术治疗。
57%的输尿管囊肿位于膀胱内，43%位于膀胱外。64.3%的输尿管囊肿与重复肾系统的上极相关。所有14例输尿管囊肿均与一个有功能的肾部分相关。内镜下切开使14例输尿管囊肿中的13例（93%）实现了输尿管囊肿减压。14例中有10例（71.4%）术前存在的肾积水得到改善或缓解。减压后肾功能未显示有显著改变或改善。13例患者中有5例（38%）在平均14个月的随访期内，因复发性尿路感染、上极膀胱输尿管反流、肾积水及下极膀胱输尿管反流需要进行确定性手术重建。
经尿道切开术在儿童输尿管囊肿治疗中的作用有限。在许多甚至大多数情况下，不能期望它成为输尿管囊肿的长期确定性治疗方法。它主要适用于患有尿脓毒症、伴有功能性膀胱颈梗阻的脱垂性输尿管囊肿或大量反流至其他肾段的患者。在这些情况下，它能可靠地实现减压并有效治疗感染。可在稍后时间重新评估先前梗阻肾段的功能，以评估是否应保留该肾段。这种延迟允许有暂时的生长，这可能会使膀胱重建更容易。
