腹腔镜治疗单侧肾发育不良伴输尿管异位开口9例报告

目的:探讨单侧肾发育不良伴输尿管异位开口患者的诊断及腹腔镜治疗。方法:回顾性分析2006年5月~2014年5月期间行腹腔镜手术治疗的9例单侧肾发育不良伴输尿管异位开口患者的临床资料:患者均为女性,左侧6例,右侧3例。经彩色多普勒超声、静脉尿路造影(IVU)、阴道逆行造影、CT、MRI等检查证实。7例输尿管异位开口于阴道壁,2例开口于前庭。所有患者均接受了腹腔镜下发育不良肾及输尿管切除术。结果:所有患者手术顺利,无中转开放手术者,手术平均时间94min(64~148min)。术后随访0.25~8年,所有患者术后尿失禁症状均消失。结论:通过病史、体格检查及影像学检查可以确诊单侧肾发育不良伴输尿管异位开口,腹腔镜下切除发育不良肾及输尿管疗效确切,是目前治疗的最佳选择。     

腹腔镜半肾输尿管切除术治疗成人重复肾(附15例报告)

目的 探讨经腹腔入路腹腔镜半肾输尿管切除术治疗成人重复肾的手术方法 和效果.方法 采用经腹腔入路腹腔镜半肾输尿管切除术治疗成人上半重复肾患者15例.男5例,女10例,平均年龄28岁.左侧11例,右侧4例.观察手术时间,术中出血量和术中术后并发症及手术效果.结果 15例手术均成功.手术时间41～115 min,平均84 min.术中出血量5～150 ml,平均55 ml.术后住院时间4～8d,平均5.9d.术中和术后未出现明显并发症.随访3～24个月,平均15个月,下半肾功能良好.结论 经腹腔入路腹腔镜半肾输尿管切除术治疗成人重复肾具有视野清晰,创伤小,出血少,恢复快,对下肾影响小等特点.     

小儿肾发育不良的腹腔镜手术治疗

目的:探讨腹腔镜手术治疗小儿肾发育不良的具体实施策略。方法:我院为9例肾发育不良患儿施行经腹腔腹腔镜肾输尿管切除术。结果:平均手术时间(78±33)min,术后12～16h恢复正常饮食,留置导尿管8～24h,术后无腹胀、呕吐等不适,无切口并发症及尿路感染,观察1～4d后出院。术后病理检查均证实为肾发育不良。随访3个月～4年,1例6岁患儿晨起时偶发滴尿,经近8个月的排尿控制训练后,症状明显好转。结论:在腹腔镜手术操作中,直接寻找发育不良的肾脏往往比较困难,女性患儿从输卵管压下方的输尿管远端着手,多可收到良好的效果。结合本病的病理特性及儿童的自身特点,腹腔镜手术治疗小儿肾发育不良是目前的最佳选择之一。     

腹腔镜下重复肾及输尿管切除治疗重复肾的疗效分析

目的 探讨腹腔镜手术治疗重复肾双输尿管畸形的可行性和疗效.方法 回顾性分析8例重复肾双输尿管畸形的临床资料.重复肾均位于肾上极,其中左侧5例,右侧3例,均为单侧.术前均经影像学确诊.4例行经后腹腔镜重复肾重复输尿管切除术,4例采用经腹腔途径完成手术.观察手术时间、术中出血量、术中术后并发症及手术效果,术后随访采用排泄性尿路造影( IVU)及彩超观察保留肾脏的功能情况.结果 8例手术均获得成功,无中转开放手术.手术时间110 ～ 170 min,平均142 min;术中出血量10～100 ml,平均20ml,无手术输血者.术后24 ～ 72h进流食,术后3～4天拔除引流管.术后住院时间7～8天,平均7.5天.8例术后随访3～24个月,平均12个月.术中术后均未发生严重并发症.随访3～24个月,1例因输尿管残端炎需要再次入院手术治疗.其余7例IVU和彩超显示下半正常肾功能良好,原发病的症状消失.结论 腹腔镜手术治疗重复肾双输尿管畸形具有创伤小、并发症少、恢复快等优点,值得临床推广应用,术中应尽量彻底切除重复输尿管全程,防止残端感染等情况的发生,经腹入路具有一定优势.     

腹腔镜输尿管输尿管端侧吻合术在小儿重复肾中的应用

目的 探讨腹腔镜输尿管输尿管端侧吻合术治疗小儿重复肾的安全性和有效性。方法 回顾性分析2020年6月～2021年12月9例重复肾上组肾积水行腹腔镜输尿管输尿管端侧吻合术的临床资料。年龄3个月～8岁(中位年龄7个月)。左侧6例，右侧2例，1例双侧重复肾伴左侧上组肾积水。2例术前检查提示上组肾对应输尿管异位开口于阴道或膀胱颈部，6例伴输尿管末端膨出。先行膀胱镜检查及患侧下组肾输尿管内双J管置入，于下组肾输尿管远端行腹腔镜输尿管输尿管端侧吻合。结果 9例均顺利完成腹腔镜手术，无中转开放手术。术中无并发症，术中出血量<10 ml。手术时间180～240(202.2±21.1)min。住院时间7～10(8.5±0.9)d。术后4～6周拔除双J管，2例双J管留置期间尿路感染。9例术后随访6～21(11.7±5.1)月，复查超声均提示上组肾积水较前减轻，7例上组肾扩张的输尿管直径较前缩小。一例8岁女性患儿术前输尿管异位开口存在尿失禁，术后症状完全消失。结论 初步经验表明腹腔镜输尿管输尿管端侧吻合术对小儿重复肾是一种安全、有效的术式选择。     

重复肾,重复输尿管畸形的诊断与治疗（附20例报告）

报告重复肾，重复输尿管畸形２０例，其中单侧畸形１５例，双侧畸形５例，并发输尿管异位开口８例，输尿管囊肿４例，重复肾上肾积水７例，重复肾上肾发育不良伴下肾积水，输尿管末端狭窄１例，结合文献分析了ＩＶＵ，Ｂ超和ＣＴ的诊断价值，提出了ＣＴ对双侧重复畸形伴一侧输尿管异位开口具有定侧诊断价值，指出可针对不同情况采取相应的治疗方法及手术方式。     

单侧肾发育不全伴输尿管异位开口8例报告

我院自1989年9月~1996年10月共收治单侧肾发育不全伴输尿管异位开口8例，现报告如下。1资料与方法1．1临床资料本组8例均为文件，年龄11个月～6岁，左、右侧各4例。临床症状主要为分次排尿伴持续性液尿。B超检查提示肾缺如，未能深及发育不良的肾脏。IVU检查发育不良例肾脏均未显影，对侧肾脏显影正常，并有不同程度的代偿性增大；膀优显影正常。6例行CT检查未发现发育不良例肾脏，2例行核素扫描提示肾缺如。5例术前寻找异位输尿管开口，4例发现尿液从阴道溢出，1例于尿道口下方见尿液流出，由此处插管造影成功，显示较细的输尿管和小肾…     

双侧重复肾伴输尿管异位开口的定侧诊断及治疗

报告我院手术治疗的１０例双侧重复肾伴输尿管异位开口患者，其中９例为单侧输尿管异位开口，１例为双仙输尿管异位开口，开口均位于前庭。经手术治疗均痊愈出院。笔者着重对定侧诊断及治疗原则进行讨论，认为静脉尿路造影、逆行插管造影及膀胱镜检查有重要价值；手术应根据重复肾及输悄管病变程度而定。     

经腹膜后入路机器人辅助单孔腹腔镜肾部分切除治疗孤立肾肾癌合并双肾盂双输尿管畸形一例报道

南京中医药大学附属医院泌尿外科2021年4月收治1例左侧孤立肾合并肾透明细胞癌患者,术前行MRI检查提示患者同时合并罕见的双肾盂双输尿管畸形变异。经术前充分评估,考虑患者解剖变异较大,为避免术中重复肾盂及输尿管损伤,笔者为患者行经腹膜后入路机器人辅助单孔腹腔镜手术。术中充分游离左肾动脉,精准阻断肾下极供应血管,行根治性肾部分切除术。手术进展顺利,手术时间为80min,术中出血量为30ml,无围手术期并发症发生,患者术后顺利出院。孤立肾双肾盂双输尿管重复畸形合并肾透明细胞癌病例罕见,需进行充分的术前影像学评估。经腹膜后入路的机器人辅助单孔腹腔镜手术中解剖精细,创伤小,术后恢复快,是临床可行的手术方式。     

腹腔镜肾输尿管全长切除术及膀胱袖状切除术治疗上尿路移行细胞癌

目的:评价腹腔镜经腹腔径路行肾输尿管全长切除术及膀胱袖状切除术治疗上尿路移行细胞癌的有效性及安全性。方法:对6例上尿路移行细胞癌患者行腹腔镜经腹腔径路肾切除术,经同侧下腹斜切口、袖状切除输尿管并完整取出标本。结果:6例手术均获成功,无中转开放手术,手术时间200～320min,平均250min,术中出血100～300ml,均未输血,住院8～12d,平均9d,术后常规膀胱灌注丝裂霉素,随访2～14个月,均无复发或转移。结论:腹腔镜肾输尿管全长切除术是治疗上尿路移行细胞癌安全有效的微创手术,具有痛苦小、康复快等优点。     

Laparoscopic nephroureterectomy for dysplastic kidney in children: an initial experience

BACKGROUND: Laparoscopic nephroureterectomy for dysplastic kidney is now becoming a widely accepted procedure. We report here our initial experience with laparoscopic nephroureterectomy in four girls. METHODS: Between 1993 and 1999, laparoscopic nephroureterectomy was performed in four girls (mean age 5.3 years). Three patients had an ectopic dysplastic kidney with ectopic ureter, and one patient had hydronephrosis with megaureter due to distal ureteral atresia of the upper moiety in a duplicated dysplastic kidney. The transperitoneal approach was used in all cases. RESULTS: Mean operative time was 195 min (range 150-266). Blood loss was minimal. All operations were completed successfully and there were no intraoperative or postoperative complications except for subcutaneous emphysema in one patient (case 4). Postoperative analgesia was used in three patients and administered in the form of diclofenac sodium suppositories 12.5 mg (cases 1 and 2) or acetaminophen suppositories 50 mg (case 3) for 1-2 days. One patient did not require any analgesia (case 4). Oral fluid intake was resumed on the first postoperative day and ambulation began within 1-3 days (mean 1.6, cases 1, 2 and 3) and 6 days (case 4). All children returned to normal activity within 3-6 days of surgery. Mean postoperative hospital stay was 7.3 days. All cases had uneventful courses after discharge. CONCLUSION: Laparoscopic nephroureterectomy can be performed safely, with minimal postoperative pain, excellent cosmetic results and early ambulation. We advocate the use of laparoscopy for the diagnosis and treatment of dysplastic kidney with ectopic ureter.     

Laparoscopic nephrectomy for a single-system ectopic ureter draining a small, dysplastic and poorly functioning kidney in children

PURPOSES: To assess the efficacy of laparoscopic nephrectomy for a single-system ectopic ureter draining a dysplastic kidney in children. PATIENTS AND METHODS: Between February 1999 and September 2005, 16 girls with a mean age of 6.2 years (range: 2-15 years) presented with urinary incontinence accompanied by regular voiding since birth (15 patients) and vaginitis (one patient). Ultrasonography, intravenous urography and a 99mTc-DMSA renal scan showed the presence of only a single kidney in all cases. Computed tomography (CT) showed a dysplastic kidney definitely in nine patients, structures suspicious of dysplastic kidney in three cases, and no dysplastic kidney in four cases. Magnetic resonance imaging was carried out in the four cases with non-visualized dysplastic kidneys by CT, and showed a suspicious lesion in only one case, and no lesion in the other three patients. All patients underwent transperitoneal laparoscopic nephrectomy for a dysplastic kidney. RESULTS: Laparoscopy identifies all dysplastic kidneys easily, even in those cases in which dystrophic kidney could not be identified by preoperative imaging. Dysplastic kidneys and ectopic ureters were removed successfully in all 16 patients. Mean operative time was 109 min (range: 40-155 min) with little intraoperative bleeding. Mean postoperative hospital stay was 2.6 days (range: 2-4 days). No intraoperative complication was encountered, except in one single case, in which a small bowel injury occurred during open Hasson's procedure. All patients became dry soon after the operation. CONCLUSION: Laparoscopic nephrectomy for an ectopic ureter draining into a dysplastic kidney is a safe and effective method, and can be carried out successfully, despite a failure by preoperative imaging studies to localize the dysplastic kidney.     

Laparoscopy as the investigation and treatment of choice for urinary incontinence caused by small 'invisible' dysplastic kidneys with infrasphincteric ureteric ectopia.

OBJECTIVE: To report our experience of using laparoscopy for the accurate location and simultaneous removal of small dysplastic kidneys with ectopic ureteric insertion causing urinary incontinence and that were not detected by conventional imaging modalities. PATIENTS AND METHODS: Seven girls (mean age 7.9 years, range 3.5-13) presented with urinary leakage occurring between normal voids. Imaging studies including ultrasonography, renal scintigraphy, intravenous urography, computed tomography and/or magnetic resonance imaging in six of the seven patients revealed a single normal functioning kidney, but failed to detect the contralateral nonfunctioning dysplastic kidney. All patients were examined under anaesthesia, followed by transperitoneal laparoscopy for the simultaneous localization and removal of the dysplastic kidneys under the same setting. RESULTS: Laparoscopy in all seven patients revealed a small dysplastic kidney that could always be easily located by first finding the draining ureter over the iliac vessels and then following it upwards. Four dysplastic kidneys were found in the renal fossa (two left, two right). One kidney was found at the left iliac fossa just above the pelvic brim, one at the left lumbar region, and the other at the right iliac fossa. Laparoscopic nephroureterectomy was successful in all seven girls and the patients were discharged 48 h after surgery. The follow-up (mean 2.7 years, range 3 months-5.4 years) showed excellent cosmetic results and all the patients have remained completely dry. CONCLUSIONS: In patients with a classical picture of urinary incontinence caused by infrasphincteric ureteric ectopia associated with a small nonfunctioning kidney, video-laparoscopy, with its magnifying effect, can reliably confirm the diagnosis, locate the dysplastic kidney and allow its removal in the same setting. We propose that laparoscopy should be considered the investigation and treatment of choice in such patients, and should be undertaken without delay even if the dysplastic kidney or the ectopic ureteric orifice cannot be identified with all other conventional means.     

Laparoscopic transperitoneal nephrectomy is feasible in the first year of life and is not affected by kidney size

PURPOSE: We analyzed the feasibility of laparoscopic nephroureterectomy in children younger than 1 year, with regard to size of impaired kidney. MATERIALS AND METHODS: A total of 40 consecutive children underwent transperitoneal laparoscopic nephrectomy during a 4-year period. Of the patients 19 (48%) were younger than 1 year and were analyzed in detail. Nine of these patients (47.4%) had a multicystic dysplastic kidney, 9 (47.4%) had reflux nephropathy and 1 (5.3%) had obstructive nephropathy. The duration of operation, reasons for conversion, and intraoperative and postoperative complications were prospectively documented. RESULTS: Mean operative time was 133 minutes (range 60 to 240), and did not differ significantly between patients up to age 12 months compared to children 1 year and older (126 vs 148 minutes, NS). Nephroureterectomy was completed laparoscopically in 17 of 19 children (89%) up to age 12 months vs 20 of 21 (95%) 1 year and older (NS). In 1 child younger than 1 year suture dislocation at the renal artery required laparoscopic resuturing. No further complications were seen. In children younger than 1 year the mean operating time was not significantly different for resection of multicystic dysplastic kidney (8 patients, 113 minutes) compared to reflux nephropathy (9, 134 minutes, NS). Mean operating time did not differ significantly for kidney volumes less than 10 cc (8 patients, 119 minutes) compared to kidney volumes greater than 10 cc (9, 129 minutes, NS). CONCLUSIONS: The feasibility of transperitoneal laparoscopic nephroureterectomy in children younger than 1 year is excellent. The duration of operation is not affected by patient age, underlying disease or kidney size.     

完全腹腔镜肾盂输尿管癌根治术治疗上尿路肿瘤32例报告

目的探讨完全腹腔镜肾盂输尿管癌根治术治疗上尿路肿瘤的疗效。方法 2007年11月～2011年3月行完全腹腔镜肾盂输尿管癌根治术32例。70°～90°健侧卧位,建立人工气腹,于脐缘、平脐腋前线、锁骨中线肋缘下和脐与耻骨联合连线中点置入trocar,先在肾周筋膜外切除肾脏后,向下游离输尿管至膀胱壁段,膀胱充水后打开膀胱,吸净液体,观察双侧输尿管开口,袖状切除患侧输尿管,3-0可吸收线连续缝合膀胱切口,2-0可吸收线间断加固肌肉层,腰部取5～7 cm切口取出标本。结果 32例手术均获成功,无中转开放手术。手术时间80～150 min,平均100 min。术中出血量80～200 ml,平均150 ml。引流量50～150 ml/d,平均100 ml/d,术后24～48 h拔除引流管。术中、术后无明显手术并发症。住院时间7～14 d,平均9 d。32例病理诊断均为尿路上皮癌。32例随访4～40个月,平均23.2月,1例术后1年死于肺转移,其余均无瘤生存。结论完全腹腔镜肾盂输尿管癌根治术具有创伤小、术后恢复快的优点,是一种安全、有效的治疗方法。     

Laparoscopic nephroureterectomy to exclude upper urinary tract malignancy associated with analgesic nephropathy.

BACKGROUND AND PURPOSE: Analgesic abuse is a potential cause of end-stage renal disease. Such patients bear an elevated risk of developing malignancies, predominantly transitional-cell carcinoma. We report our experience with laparoscopic nephroureterectomy carried out in patients with analgesic nephropathy to exclude upper urinary tract malignancy. All patients were scheduled to be put on the waiting list for cadaveric renal transplantation. PATIENTS AND METHODS: Since 1996, nine women and two men with a long-term history of analgesic abuse have undergone laparoscopic nephroureterectomy at our hospital. The median age was 63 years (range 51-70 years). All patients had developed end-stage renal failure secondary to heavy analgesic abuse with a median duration of 14 years (range 7-40 years). The median interval from the beginning of hemodialysis to laparoscopic nephroureterectomy was 36 months (range 6-76 months). RESULTS: The median operative time was 99 minutes (range 55-170 minutes). There were no conversions to open surgery. Two complications occurred, and three patients required blood transfusions. The median hospital stay lasted 5 days (range 2-12 days), and the median convalescence was 20 days (range 6-44 days). In seven patients, histopathologic examination of the kidney revealed changes attributable to analgesic abuse. None of the patients had a transitional-cell carcinoma, but in two patients, a renal-cell carcinoma stage pT1cN0cM0 grade 2 was detected. CONCLUSION: Patients with analgesic nephropathy bear an elevated risk for the development of transitional-cell or renal-cell carcinoma. In these patients, laparoscopic nephroureterectomy combines minimally operative invasiveness with a maximum of diagnostic safety.     

Laparoscopic nephroureterectomy in children

BACKGROUND/PURPOSE: Laparoscopic surgery is playing an increasingly important role in pediatric urology. It has emerged as an alternative means of performing nephroureterectomy. The authors report their experience with laparoscopic nephroureterectomy in children. METHODS: Between July 1996 and August 1997, six patients aged between 3 months and 5 years, 9 months (average, 35 months) underwent laparoscopic nephroureterectomy. The transperitoneal approach was used in all cases. RESULTS: Operating times ranged from 110 to 265 minutes, averaging 176 minutes. No early or late postoperative complications were noted. Five of six patients resumed oral feeding on the first postoperative day. Four of six patients were discharged on the second postoperative day. CONCLUSIONS: Laparoscopic nephroureterectomy is a safe and feasible alternative to the open method in children. It is associated with good surgical results and favorable postoperative patient recovery.     

Laparoscopy for definite localization and simultaneous treatment of ectopic ureter draining a dysplastic kidney in children

BACKGROUND AND PURPOSE: Single-system ectopic ureter draining a dysplastic kidney is a rare urologic abnormality. In this study, we evaluated our own experience using laparoscopy for the simultaneous identification and removal of such ureterorenal units. PATIENTS AND METHODS: Between February 1999 and August 2001, four girls with a mean age of 11 years presented with urinary incontinence. After imaging studies including CT scan, MRI, or both were done, all the patients underwent laparoscopy for definitive localization and simultaneous treatment. RESULTS: In all cases, ultrasonography and intravenous urography combined to reveal a single normal kidney. Even the CT scan could not identify the dysplastic kidney or ectopic ureter in three children. Laparoscopy was performed transperitoneally in all four patients, and a small dysplastic kidney was identified. Discovery of the kidney was not difficult because we initially identified the ureter crossing over the iliac vessels. Laparoscopic nephroureterectomy was successful in all patients with a mean operative time of 102 minutes. There was no significant intraoperative or postoperative complication, and the mean postoperative hospital stay was 2.5 days. All patients have remained completely dry without any problems after surgery. CONCLUSIONS: For patients having a clinical suspicion of ectopic ureter draining a dysplastic kidney, laparoscopy may represent an alternative modality for simultaneous diagnosis and treatment.     

Simultaneous laparoscopic nephroureterectomy and robot-assisted radical cystectomy: Lessons learned from our initial experience

Background:In patients with high-risk bladder cancer and concomitant upper urinary tract malignancies, simultaneous cystectomy and nephroureterectomy is the principle oncological procedure of choice. Nevertheless, there are still not many reports of simultaneous robot-assisted radical cystectomy (RARC) and nephroureterectomy. Therefore, the aim of this study was to evaluate outcomes and complications of simultaneous RARC and laparoscopic nephroureterectomy in our institution.Materials and methods:This case series evaluated our initial clinical results of 3 patients who underwent simultaneous laparoscopic unilateral nephroureterectomy and RARC with the da Vinci Xi system between 2019 and 2020 at our hospital. Demographic data, preoperative parameters, and postoperative parameters were retrospectively analyzed.Results:All 3 patients were men whose median age was 75 years (range 73–89 years). The median total operative time was 435 minutes (range 429–484 minutes), median estimated blood loss was 377 mL (range 125–410 mL), and median hospital stay was 26 days (range 21–36 days). In all 3 cases, each trocar was used in 7 ports. The postoperative complications were stratified according to the Clavien-Dindo Classification system, and a grade 3B complication developed in 1 patient: trocar site herniation of the small bowel.Conclusions:We reported our initial experience of simultaneous laparoscopic nephroureterectomy and RARC. A large-scale prospective, randomized, controlled trial will be required to prove the feasibility and safety of simultaneous laparoscopic nephroureterectomy and RARC.