先天性输尿管开口异位26例

目的探讨小儿先天性输尿管开口异位的诊断和治疗方法。方法回顾性分析本院1995年2月至2008年2月收治的26例先天性输尿管开口异位病例资料。其中18例为单侧重复肾、重复输尿管并输尿管开口异位，1例为双侧重复肾、重复输尿管并单侧输尿管开口异位，5例为先天性肾发育不良并输尿管开口异位，2例为单侧肾异位伴发育不全输尿管开口异位。结果均经手术治疗，其中16例行上肾部输尿管切除术；1例行患肾上肾部及输尿管切除术；2例行输尿管膀胱再植术；5例肾发育不良和2例异位肾并肾发育不全输尿管开口异位患儿行患肾及输尿管切除术。26例均痊愈出院，获6个月至1年的随访，滴尿症状均消失，2例术后半年行膀胱尿道造影未见膀胱输尿管返流，疗效满意。结论先天性输尿管开口异位易误诊或漏诊，B超、静脉肾盂造影、磁共振泌尿系统水造影是诊断的主要手段；诊断明确者应尽早手术治疗。     

小儿输尿管异位开口的诊治

目的 探讨小儿输尿管异位开口的诊断及治疗。方法 回顾总结16例小儿输尿管异位开口的诊治。结果 一侧重复肾上肾段输尿管开口9例，其中7例行重复肾上肾段及输尿管切除，2例行异位输尿管与膀胱抗反流移植术；单侧单一输尿管异位开口7例，均行患肾及输尿管切除术；16例术后滴尿症状消失。结论 本病一经确诊，应及时手术治疗。IVP与B超检查相互补充，有助于异位输尿管开口的定侧及手术进路，手术方法依双肾功能而定。     

先天性单侧肾发育不良的诊治体会(附23例报告)

目的总结先天性单侧肾发育不良的诊治经验。方法回顾性分析23例先天性单侧肾发育不良的临床资料。其中女20例,男3例。年龄2～14岁。合并肾位置异常2例,输尿管异位开口15例,双侧输尿管囊肿1例,输尿管积水3例,膀胱输尿管返流(VUR)1例。对侧重复肾并输尿管异位开口2例,膀胱输尿管返流1例。B超检查21例,IVP检查22例,输尿管逆行造影4例,膀胱镜检查10例,CT检查13例,VCU检查2例。均行手术治疗,其中肾切除19例;输尿管囊肿电切开窗1例;对侧重复肾切除2例;膀胱输尿管再吻合1例。结果全部病例随访6个月～3年,漏尿、发热及尿路感染等症状消失。结论临床症状结合影像学检查是诊断先天性单侧肾发育不良的有效方法,单侧肾发育不良常合并输尿管末端及对侧肾脏病变。治疗上主要是切除发育不良的肾。     

计算机辅助手术系统在小儿重复肾精准手术中的应用

目的探讨海信计算机辅助手术系统(Hisense CAS)在小儿重复肾精准外科手术中的诊疗价值及临床意义。方法回顾性分析2013年1月至2017年6月青岛大学医学院附属医院收治的35例重复肾患儿的临床资料,利用海信计算机辅助手术系统对患儿腹部、盆腔薄层CT图像进行泌尿系统CT三维重建和术前规划,准确判断重复肾的位置、大小,肾脏周围血管系统走行、分支及毗邻关系,输尿管走行、狭窄段等,明确手术的可行性及手术方案,分析手术时间、术中出血量、输血率、并发症等。结果 35例重复肾患儿CAS三维重建结果清晰显示重复肾的位置、大小、毗邻关系及重复肾周围血管的走行、分支等。35例重复肾患儿中,左侧19例,右侧13例,双侧3例;完全性重复肾32例,不完全性重复肾(Y型输尿管) 3例; 35例均为上位型,重复肾肾盂输尿管扩张、积水35例,其合并上肾段输尿管末端囊肿9例(下肾段双输尿管Y性吻合并上肾段输尿管末端囊肿1例),合并Y型输尿管、下肾段肾盂-输尿管连接处狭窄1例,合并上、下肾发育不良1例。1例行单侧肾切除术,1例行肾盂成形术,32例行肾-输尿管切除术,1例行输尿管-膀胱吻合术; 2例二次手术行囊肿切除。手术时间50～210 min,平均为122. 8 min,术中平均出血量12. 91 m L,最少出血量为1 m L。35例中有2例术后输注1 u红细胞,术后平均住院时间9 d,均痊愈出院。结论通过海信计算机辅助手术系统对CT数据进行三维重建并辅助设计最优手术方案,可提高重复肾手术切除的准确性、安全性。     

先天性输尿管异位开口的诊断和治疗

目的提高先天性输尿管异位开口的诊治水平 方法 分析输尿管异位开口15例的临床资料。15例均为女童,年龄2个月-14岁 单侧重复肾重复输尿管异位开口13例,双侧重复肾重复输尿管、一侧上半肾输尿管异位开口1例,单侧单输尿管异位开口并盆腔异位1例 均既有正常分次排尿,又有持续漏尿 异位开口位于前庭9例,阴道、尿道各3例 结果 肾切除2例、半肾切除11例、上下输尿管端侧吻合2例,术后漏尿症状均消失。结论根据典型临床表现和B超、静脉肾盂造影、逆行插管造影可明确诊断根据肾脏发育程度及其功能,合理选择手术方式是治疗小儿异位输尿管开口的主要方法     

双侧肾母细胞瘤的诊治与预后

为总结双侧肾母细胞瘤(BWT)的诊治经验，对1960年至2000年收治的10例BWT患儿的临床资料进行回顾性分析，结果显示BWT发病年龄小，病理分型良好。同时发病的6例BWT中，3例接受一侧肾切除，另侧行肾部分切除或肿瘤切除术，3例行双侧肾部分切除或肿瘤切除术。异时发病的BWT4例，首诊时全部接受患肾切除术，诊断BWT时1例行活检术后放弃治疗，2例行肾部分切除术，1例行肿瘤切除术。提示早期诊断与术前、后化疗有助于保肾及提高生存率，对BWT术后不主张积极的放疗。保留一侧2／3肾或双侧1／2肾是保证患儿长期生存与生活质量的重要因素。     

泌尿生殖系统疾病

040306重复肾输尿管畸形的诊断与治疗/毛和平…//实用儿科临床杂志一2003,18(7)一566一567 环例重复肾输尿管畸形患儿,单侧13例,双侧3例.其中13例伴一侧输尿管异位开口;通过静脉肾盂造影、B超、膀肌镜检查确诊;15例行手术治疗,痊愈出院。]例保守治疗症状消失出院。13例行输尿管膀胧再植术者定期复查B超,手术一侧重复肾孟、输尿管积水明显减轻或消失。参3(姜红) 0403()7输尿管畸形68例/单磊…//实用儿科临床杂志一2003,18(7)一567一568 B超确诊63例,确诊率93%。静脉肾盂造影确诊5。例,确诊率74%;CT检查10例,确诊8例;膀胧镜检查2魂例、确诊6…     

重复肾输尿管畸形的诊断与治疗

目的 探讨重复肾输尿管畸形的诊断与治疗。方法 16例重复肾输尿管畸形患儿，单侧13例、双侧3例，其中13例伴一侧输尿管异位开口；通过静脉肾盂造影(IVU)、B超、膀胱镜检查确诊；15例行手术治疗，1例保守治疗。结果 经治疗均痊愈出院，术后随访1～8年疗效满意。结论IVU、B超诊断有重要意义，治疗应根据重复肾、输尿管病情及其并发症而定。     

一期手术矫治肾输尿管重复畸形合并异位输尿管囊肿

目的 探讨分析完全性肾输尿管重复畸形合并同侧上输尿管异位囊肿的病人，治疗时是否需要同时切除病变肾和输尿管囊肿。方法 对近8年来我院收治的10名完全性肾输尿臂重复畸形合并同侧上输尿管异位囊肿的病例予以总结。结果 发现其中6名初期治疗中仅切除患侧上半肾输尿管的儿童，平均术后1年都因为膀胱内囊肿增大而再次接受了输尿管囊肿切除术。另3例病人一期同时施行了上半肾输尿管切除术、膀胱内输尿管囊肿切除术和下半肾输尿管再植术，术后随访疗效良好。结论 我们认为对类似疾病应该在切除肾输尿管的同时一并切除异位输尿管囊肿。     

单纯上或下患肾部输尿管膀胱外再植治疗完全性重复肾畸形

目的 评价采用单纯上或下患肾部单根输尿管膀胱外再植治疗完全性重复肾畸形的疗效.方法 从2009年12月1日起至2014年12月31日间,我科采用单纯上或下患肾部单根输尿管膀胱外再植治疗完全性重复肾畸形患儿27例,均为单侧病变,女19例,男8例,年龄2个月至8岁.所有患儿经影像学检查明确诊断为完全性重复肾畸形且均为单根输尿管病变.其中上输尿管异位开口者9例;重复上肾上输尿扩张积水伴上输尿管末端囊肿者10例;重复下肾部输尿管单纯反流者8例.临床症状主要表现为正常排尿间歇性滴尿或发热性尿路感染.所有患儿术后随访观察11个月至6年,随访项目包括泌尿系统超声、同位素和膀胱造影等.结果 所有患儿手术过程顺利,平均手术时间63 min,术后平均住院时间为5d,术后所有患儿临床症状均消失.术后有1例患儿因血尿检查发现再植输尿管开口处结石形成,予以行膀胱镜下钬激光碎石术.术后6个月复查超声示患肾部积水均有好转,同位素示患肾部功能改善或稳定,正常肾部功能未见异常改变.7例患儿术后复查排泄性膀胱尿道造影检查未见膀胱输尿管反流等发生.结论 经腹股沟皮纹小切口单纯上或下患肾部单根输尿管膀胱外再植术治疗完全性重复肾畸形是一种安全、有效的方法,值得临床推广.     

Complications of pyelo-ureteral duplications in children and their surgical treatment. Apropos of 69 cases (78 pathogenic duplications)

The authors report their experience on the surgical treatment of 69 infants and children with pyelo-ureteral duplication. Urinary infection was the main revealing symptom (52 cases). Vesico-ureteral reflux was the major associated anomaly (39 cases) involving most often the lower pole ureter; the surgical correction of the reflux was performed according to the technique of Cohen with a favorable outcome in all cases. Because of poorly functioning and dysplastic upper renal segment, partial upper pole nephrectomy was performed in 8 among 12 cases of associated ectopic ureteral orifice and in 9 among 15 cases of associated ureterocele. A reimplantation of the ureter was made possible in 3 cases of ectopic ureteral orifice and in 5 cases of ureterocele with little corresponding renal lesions. With the experience of one neonate who died from septic shock following partial nephrectomy there were no other post-operative complications in this series.     

Experience with a novel approach to upper-pole nephrectomy and partial ureterectomy

The upper-pole moiety of a renal duplication anomaly associated with an ectopic ureter or ureterocele is often hydronephrotic and non-functioning. Thus, the treatment of choice is frequently upper-pole nephrectomy and partial ureterectomy. Previous surgical techniques have emphasized the initial removal of the upper pole followed by partial ureterectomy. The approach described here begins by identifying and dissecting the obstructed upper-pole ureter, dividing it distally, and performing the partial nephrectomy last. We have performed this procedure on 12 consecutive nonfunctioning and obstructed upper-pole moieties of duplicated kidneys. In 10 patients the obstructed upper pole was associated with an ectopic ureter or an ectopic ureterocele (bilateral in 1) and in 1 with uretero-pelvic junction obstruction of the upper-pole moiety. This anatomic approach has resulted in preservation of function in all 12 remaining lower renal and ureteral units as assessed by postoperative intravenous urography. Only 1 patient required an intraoperative blood transfusion. We believe that this safe and easy-to-teach approach should be included in the urologic armamentarium.     

44例小儿重复肾的诊治分析

目的探讨小儿重复肾的诊断方法和手术技巧,以提高其诊治水平。方法回顾性分析2006年9月至2011年10月经作者手术治疗的44例重复。肾患儿临床资料,其中男性10例,女性34例,年龄1个月至13岁,平均年龄2．2岁。均采用B超、MRU、IVU等相结合的方法进行诊断。均行重复肾及所属输尿管切除术。结果44例患儿术中诊断与术前相符,均经手术治疗痊愈出院。42例获随访,随访时间7个月至5年,3例出现输尿管残端综合征,经手术切除输尿管残端后治愈。1例术后出现残肾断面漏尿,经肾周引流管流出,术后6d漏尿停止,B超检查无肾周积液,拔除引流管后康复出院。其余患儿恢复良好。结论B超、IVU、MRU等相结合是诊断小儿重复肾畸形的主要方法,可确诊重复肾;CTU、VCU对诊断有补充作用。手术切除重复肾是治疗重度积水、扩张重复。肾的主要方法,尽量低位切除重复输尿管、完全切除重复肾、保护残留。肾肾盏及所属正常输尿管是手术成功的关键。     

Spectrum of ectopic ureters in children

We reviewed the clinicopathological features, diagnosis, and surgical treatment of ectopic ureters (EU) in children in order to evaluate the anatomy, renal function, outcome, and the existence of any racial or regional difference in this abnormality. The records of 27 consecutive patients with 33 EU managed over a period of 7 years were analyzed. There were 25 female and two male patients. Their age ranged from 1 to 13 years, with an average of 4.5 years. The presenting features included history of continuous dribbling of urine with otherwise normal voiding in toilet-trained female patients, incontinence of urine, urinary tract infection, abdominal pain, and renal failure. The diagnostic work-up included ultrasonography (US) in all 27 patients, intravenous pyelography (IVP) in 23, micturating cystourethrogram (MCU) in 19, nuclear imaging (NI) in 16, and computed tomogram (CT) in five patients. All patients underwent examination under anesthesia (EUA) and cystourethrovaginoscopy immediately before the operation. Single-system ectopic ureter (SSEU) was present in 19 patients with 25 ureters (six bilateral), and duplex with ectopic ureter was present in eight cases. The left side was involved in 14 cases, the right side in seven, and the anomaly was bilateral in six cases. Abnormalities noted in the imaging studies were USG 23/27, IVP 23/23, MCU 11/19, NI 13/16, and CT 5/5 cases. EUA and cystourethrovaginocsopy helped in localization of the ectopic site and evaluation of the bladder. The surgical treatment included nephroureterectomy (NUT) for non-functioning kidney in 7 patients, heminephroureterectomy (HNUT) for non functioning upper pole of duplex kidney with EU in 6 patients, ureteric reimplantation (UTR) in 13 patients (19 ureters, 6 bilateral), and ureteropyelostomy (UTP) in one patient. In the follow-up period ranging from 1 to 5 years, 20 patients achieved continence; however, six cases with bilateral SSEU and one case of unilateral SSEU, who also had a patulous bladder neck, continued to dribble urine. SSEU was more common than duplex with ectopic ureter. A large number of functioning renal units associated with SSEU deserved preservation. The success of surgical treatment in terms of achievement of continence was high and depended on the integrity of the bladder neck.     

输尿管镜下腔内治疗婴幼儿双侧输尿管结石

目的 探讨输尿管镜下腔内治疗婴幼儿双侧输尿管结石的临床疗效.方法 采用输尿管镜下腔内逆行置入输尿管支架管引流或Ⅰ期碎石解除梗阻治疗婴幼儿双侧输尿管结石致急性梗阻18例.结果输尿管镜下Ⅰ期成功碎石4例,双侧2例,单侧2例,14例单纯逆行置入输尿管支架管引流,其中双侧逆行置管9例,单侧5例.手术时间平均38 min(25～70 min);平均住院时间8 d(4～18 d).二次手术3例,治愈17例,死亡1例.结论 输尿管镜下腔内逆行置入输尿管支架管引流或I期碎石解除梗阻是治疗婴幼儿双侧输尿管结石有效方法 之一,其微创、安全、疗效肯定.     

Laparoscopic ureteral ligation (clipping): A novel,simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties

ObjectiveA simplified approach for the surgical management of symptomatic ectopic ureters, associated with a non-functioning upper moiety, with laparoscopic ureteric clipping is presented in this research paper.Materials and methodsProspectively collected data on nine consecutive girls with ectopic ureters associated with urinary incontinence who underwent laparoscopic clipping between February 2011 and December 2013. Surgical technique consisted of cystoscopy and insertion of ureteral catheter in the lower pole ureter to aid in identification and clipping of the ectopic ureter, which was achieved by standard trans-peritoneal laparoscopy.ResultsMedian age was eight years (range 4–17 years). Diagnosis was based on clinical findings, which were supported by: ultrasound (US), nuclear scans and magnetic resonance urography in Cases 9, 8 and 5, respectively. Bilateral complete duplication was present in two patients; the combination of cystoscopy and laparoscopy allowed adequate identification of the ectopic ureter causing incontinence in both. All nine patients were immediately dry after surgery and remain asymptomatic after a maximum follow up of 27 months. Eight out of nine patients had developed some degree of asymptomatic upper pole hydronephrosis on follow-up US.ConclusionLaparoscopic clipping holds promise as a simple alternative to other more-complex surgical procedures in the treatment of incontinence due to an ectopic ureter. Despite favorable and encouraging initial results, further follow up is warranted in order to determine the fate of expected associated upper-pole hydronephrosis.     

Reconstructive surgery for lower pole ureteropelvic junction obstruction associated with incomplete ureteral duplication

IntroductionThe lower moiety of duplex kidney can be associated with ureteropelvic junction obstruction (UPJO). Surgical correction can be challenging in cases of incomplete duplication where the junction of the lower and upper pole ureters is proximal. We review our experience with this unusual entity with an emphasis on surgical techniques employed in reconstruction.MethodsWe retrospectively reviewed the charts of eight patients with lower pole UPJO who underwent surgery in 2002–2008. The surgical approach, specifically the utilization of the non-obstructed upper pole ureter, used in the reconstruction was noted.ResultsFour of eight patients were symptomatic at presentation with either infection or pain. UPJO was at least in part secondary to lower pole crossing vessels in four patients and was treated with dismembered pyeloplasty. Lower pole to upper pole pyeloureterostomy was necessary in four patients due to short ureteral length between the UPJ and junction of lower and upper pole ureters. No complications or obstruction of either moiety developed during 1 year of follow up.ConclusionsLower pole UPJO in incomplete renal duplication mandates individualized surgical treatment dependent upon anatomy encountered. We have found that pyeloureterostomy is a safe alternative to drainage of the obstructed lower pole.     

Multiple fibroepithelial polyps of the upper ureter in a 17-year-old boy--case report and review of the literature.

Benign tumours and primary malignant tumours of the ureter are uncommon in adults and extremely rare in children. The clinical symptoms are flank pain, urinary tract infection, and macro/micro-haematuria. There is an incomplete ureteral obstruction and filling defect on intravenous urography (IVU). Optimum treatment of this lesion results in renal preservation. Uretero-renoscopy is currently the best method available for the identification and histological diagnosis of ureteral polyps. Recommended operative procedures are pyeloureteric junction (PUJ) resection with Anderson-Hynes pyeloplasty, ureteric resection with end-to-end anastomosis or with uretero-cysto-neoanastomosis (UCNA), ureteric resection with renal autotransplantation. Ureteronephrectomy is not indicated. A case of ureteral polyps in a 17-year-old boy with the chief complaint of left flank pain is reported here. The excretory urogram and renal scan showed left hydronephrosis. Resection of the pyeloureteral junction, partial resection of the upper ureter containing the lesions--multiple branching 30-40 mm long polyps with a common basis--and Anderson-Hynes pyeloplasty were performed. The pathological diagnosis was benign fibroepithelial polyps of the ureter. Convalescence was uneventful and after 4 years of follow-up, excretory urogram and ultrasonography showed good renal function and improvement of hydronephrosis.     

Bladder surgery as first-line treatment of complete duplex system complicated with ureterocele

ObjectivesWe retrospectively analyzed our experience to determine the optimum management of complete duplex system complicated with ureterocele.Materials and methodsBetween 1994 and 2003, we reviewed 15 patients treated with bladder surgery for complete duplex system complicated with ureterocele. The associated anomalies were seven vesicoureteral reflux (VUR) of the lower pole ureter and one of both poles. All patients had ureterocele (11 intravesical, 4 extravesical) and a functioning upper moiety. Initial treatment was transurethral incision of ureterocele (TUI) (14) or common sheath reimplantation (1). The median follow-up was 30 (13–48) months.ResultsThere were no requirements for secondary procedures, with a significant improvement or conservation of ipsilateral renal function and no reflux, in 10 patients (67%). Five patients (33%) with ureterocele (1 intravesical, 4 extravesical) who initially underwent TUI required additional operative management due to moderate to severe VUR, recurrent urinary tract infection or decreased function of upper moiety. The secondary operation performed was lower pole nephrectomy with ureteral reimplantation (1), ureteroureterostomy with ureteral reimplantation (2) or common sheath reimplantation (2). One patient who underwent common sheath reimplantation as secondary operation needed a nephrectomy due to breakthrough febrile urinary tract infection and decreased renal function.ConclusionTUI is recommended as the first-line treatment of complete duplex system with intravesical ureterocele and well-conserved renal function.