小儿输尿管膨出症26例报告

小儿输尿管膨出症是小儿下尿路梗阻最常见的发病原因之一 ,在女孩仅次于神经性膀胱居第 2位。 1994至 2 0 0 0年我院收治 2 6例 ,现报告如下。材料与方法　本组 2 6例。男 4例 ,女 2 2例。年龄 3个月至 11岁 ,其中 <3岁者 18例。患儿均有反复尿路感染和排尿困难 ;肿物自尿道口脱出 6例 ,腹部肿物 3例 ,血尿 3例。超声及IVU检查发现重肾并输尿管膨出 2 4例 ,单一输尿管膨出 2例。左侧 10例 ,右侧 12例 ,双侧 4例。IVU检查上半肾均未显影 ,下半肾受压向外下移位 ;排泄性膀胱尿道造影 (VCU)检查 18例 ,下半肾有膀胱输尿管中、重度返流 3例…     

巨输尿管症22例诊治报告并文献复习

目的探讨巨输尿管症的治疗方法。方法回顾性分析22例巨输尿管症患者的临床资料,其中男16例,女6例;左侧12例,右侧6例,双侧4例。结果 12例行输尿管整形后膀胱再植术,6例行输尿管支架管植入术,4例行患侧无功能肾切除术。随访1~6年,12例再植术后肾功能均正常,10例肾积水明显减轻,吻合口无狭窄及膀胱输尿管无返流,2例术后输尿管及肾脏积水无改善,长期观察肾积水无加重且无临床症状,未进一步治疗;6例行支架管置入术后积水可减轻,拔出支架管后5例肾积水程度无变化,1例渐加重,伴发热,给予行肾脏穿刺引流后行输尿管膀胱再植术,术后肾积水明显减轻;4例肾切除术后对侧肾脏功能正常。结论 IVU检查诊断梗阻型巨输尿管症显影率低,MRU具有较好的应用前景;巨输尿管症治疗原则是解除梗阻,保持输尿管通畅并防止返流及狭窄;最佳手术治疗方法是进行输尿管整形(裁剪或折叠)后膀胱再植术,保守治疗也可作为治疗的选择之一。     

小儿巨输尿管症的诊断和治疗（附41例报告）

目的探讨小儿巨输尿管症（MU）的诊断和治疗。方法回顾性分析原发性MU29例（先天性9例,原发反流性12例,原发梗阻性8例）和继发性MU12例的临床资料。结杲先天性MU及原发反流性MU21例行输尿管裁剪整形及膀胱再植,随访1～2年未见异常。原发梗阻性MU中2例肾发育不良并输尿管闭锁行肾及输尿管切除,6例输尿管末端狭窄行狭窄段切除,随访2～6年,除2例术后发生输尿管残端综合症二次手术外其余未见异常。继发性MU12例在解除原发病后行输尿管裁剪整形及膀胱再植,随访3年未见异常。结论小儿MU诊断主要依据病史及影像学检查,输尿管裁剪整形膀胱再植术为有效方法;继发性MU在原发病解除后,MU无改善,应及时行MU根治术,改良膀胱外隧道式输尿管膀胱吻合术简单、效果好。     

女性重复肾输尿管及膀胱九例报告

目的 总结女性重复肾输尿管及膀胱的诊治体会. 方法女性重复肾输尿管及膀胱患者9例,平均年龄33(26～53)岁.其中重复肾重复输尿管发生在左侧6例、右侧2例、双侧1例.单侧8例重复膀胱为不完全性;双侧重复者1例为完全性重复膀胱,且合并重复尿道、重复子宫及双侧输卵管卵巢,患者重复子宫脱垂Ⅱ度,阴道前壁及重复膀胱膨出.9例均因阴道脱出肿物就诊,经查体、影像学检查并经术中证实诊断8例,1例误诊为阴道壁囊肿者术中确诊.重复肾重度积水无功能者2例行重复肾、重复输尿管全长及重复膀胱切除;重复肾存在分泌功能者7例,行重复膀胱切除、重复输尿管下段膀胱再植术6例;1例完全性重复膀胱合并重复尿道、重复子宫及双侧输卵管卵巢、重复子宫脱垂Ⅱ度、阴道前壁及重复膀胱膨出者行重复膀胱、重复子宫附件及重复尿道切除,重复输尿管下段膀胱再植术. 结果 9例手术均成功,未发生漏尿及输尿管残端综合征.7例输尿管膀胱再植者术后3个月膀胱造影显示输尿管无反流.术后12个月复查IVU,2例重复肾切除者显示患侧残肾形态及功能正常,7例输尿管膀胱再植者显示患侧肾脏及重复肾形态功能良好.合并重复子宫附件者术后1.5年妊娠. 结论影像学检查是诊断重复肾输尿管及膀胱的重要手段.手术是治疗该病的主要方法,术前应重点了解重复肾功能、输尿管形态及走向.手术方式应以解除病痛、保护患肾及重复肾功能、避免感染为原则.     

双侧巨输尿管症的临床分析(附9例报告)

目的:探讨双侧巨输尿管症的诊疗方法.方法:回顾性分析9例双侧巨输尿管症患者的临床资料:主要症状为腰痛、血尿、尿路感染等,均经B超、KUB加IVU、逆行造影、膀胱镜、尿动力学检查等予以诊断.3例肾功能尚正常者行I期双侧输尿管裁减修整、膀胱再植术;2例先行双肾造瘘术,其中1例肾功能明显改善后行双侧输尿管裁减修整、膀胱再植术,另1例肾功能及一般情况仍较差,继续保守治疗;2例一侧行肾造瘘术,另一侧行输尿管裁减修整、膀胱再植术,1年后,1例行输尿管裁减修整、膀胱再植术,另1例行一侧肾输尿管切除术;1例行一侧I期输尿管裁减修整、膀胱再植术,另一侧行肾输尿管切除术;1例肾功能正常、肾脏轻度积水,给予保守治疗.结果:术后随访1～2年,7例手术者和2例保守治疗者肾功能、肾积水均有不同程度的改善.结论:双侧巨输尿管症病因复杂,不易诊断,需综合判断.治疗时应根据病因、肾功能、年龄、肾积水及输尿管扩张程度等综合决定.输尿管裁减修整、膀胱再植术是最佳治疗方法,宜早期选用.肾脏造瘘对保护肾功能有积极作用,适用于肾功能差的患者.     

先天性巨输尿管症的临床诊治探讨:附14例报告

目的 探讨先天性巨输尿管症的诊断及治疗方法.方法 回顾性分析14 例先天性巨输尿管症的临床资料,其中左侧6 例,右侧5 例,双侧3 例,均经超声、KUB+IVP、膀胱镜逆行插管造影、CT、MRU 等检查确诊.采用输尿管中、下段裁剪、抗返流输尿管膀胱再植术9 例,因肾重度积水、功能严重受损而行肾、输尿管切除术2 例,1 例行输尿管末端切开术,2 例行保守治疗,定期更换双J 管.结果 行输尿管膀胱再植术9 例(包括先行肾盂穿刺造瘘术,3 个月后再行输尿管膀胱再植术的患者),均于6~12 周后拔除支架管或双J 管.术后随访1~3 年,经超声及IVP 检查,显示患侧输尿管扩张均明显减轻,1 例肾积水缓解不明显,于随访后第3 年行肾输尿管切除术.输尿管末端内切开术患者在术后1 年内复诊更换双J 管2 次,复查超声提示肾积水明显减轻.保守治疗的2 例患者到目前为止,病情无恶化征象.结论 超声和KUB+IVP 检查是诊断先天性巨输尿管症的首选检查方法,但MRU 和CTU 近年体现出更多的诊断优势.随着泌尿外科腹腔镜和输尿管镜等腔镜技术的发展和提高,采用腔镜技术治疗也将是必然趋势.     

改良膀胱外输尿管隧道延长术治疗小儿巨输尿管（附10例报告）

目的观察改良膀胱外输尿管隧道延长术（Lich—Gregoir法）治疗小儿巨输尿管的疗效。方法改良膀胱外输尿管隧道延长术（Lich—Gregoir法）治疗巨输尿管症10例，男8例、女2例。结果全组10例，术后恢复顺利。原发性膀胱输尿管返流（VUR）2例及输尿管囊肿1例，行排尿性膀胱尿道造影（VCU）检查，返流消失。输尿管末端狭窄3例经肾造瘘管造影，其余4例行静脉尿路造影（IVU）检查，7例输尿管均显影，VCU检查无VUR发生。结论改良膀胱外输尿管隧道延长术既能对巨输尿管做游离、松解、裁剪整形，又保留了原术式仅在膀胱外手术，不切开膀胱，延长膀胱黏膜下输尿管长度，达到抗VUR的目的，是一种适合治疗小儿巨输尿管症的手术方法。     

内窥镜手术治疗输尿管膨出13例报告

目的:观察内窥镜手术切除输尿管膨出的治疗效果.方法:回顾性分析13例成人输尿管膨出患者采用内窥镜手术治疗的临床资料.结果:13例患者均经IVU、B超及膀胱镜检查确诊,采用电切镜或钬激光机行输尿管囊肿低位横行切开术5例,3例肾积水消失,2例肾积水改善;8例行输尿管膨出囊壁部分切除,积水全部消失.均一次手术成功,术后平均随访18个月,3例术后出现输尿管反流,2例2个月后自行缓解,1例于术后4个月行开放手术抗反流.结论:内窥镜手术切除输尿管膨出是一种安全、简单、有效的治疗方法,可以减少手术创伤及术后并发症,创伤小、恢复快.囊壁部分切除术效果更为理想.当输尿管反流不能自愈时,应行输尿管膀胱抗反流吻合术.     

输尿管异位开口52例报告

目的　总结输尿管异位开口的诊治经验。　方法　对 5 2例输尿管异位开口患者临床表现、诊治方法进行回顾性分析。　结果　 5 2例患者B超检查 37例 ,IVU检查 4 5例 ,CT检查 8例 ,膀胱镜检逆行插管造影检查 18例。联合以上方法于术前确诊 4 9例 (94 .0 % )。 2 8例 (5 3.8% )患者行输尿管膀胱再植术 ,12例 (2 3.0 % )行单侧肾脏切除术 ,9例 (17.3% )行上半肾及输尿管切除术 ,1例行异位输尿管口囊肿单纯切开术。 4 2例随访 6个月～ 10年 (平均 3年 ) ,疗效满意。　结论　结合病史、体格检查和联合影像学检查 ,大多数输尿管异位开口可于术前确诊。输尿管膀胱再植术 ,上半肾和输尿管切除术及单侧肾脏切除术为有效的外科治疗方法     

输尿管膨出44例报告

目的 :探讨提高对输尿管膨出的诊断和治疗水平的方法。方法 :总结 16年收治的 4 4例患者临床资料。术前行B超、IVP、CT或膀胱镜检查。 2 4例行膨出部切除加膀胱输尿管再吻合术 ,其中 8例同时切除了同侧上肾和输尿管。 2 0例行经尿道内腔镜囊肿切开治疗。结果 :B超和IVP两种检查结合可明显提高诊断符合率 ,膀胱镜检的准确率可达 10 0 %。随访 1～ 16年 ,其中 1例患者有待接受第二次手术 ,所有患者术后症状改善 ,复查显示积水消失 ,无尿液反流。结论 :B超和IVP是理想而必要的检查 ,对手术方法的选择有指导意义。治疗以手术为主 ,并发有重复肾输尿管畸形或输尿管膨出部巨大 (直径 >3cm)的病例 ,宜行上肾及输尿管切除或 (和 )膨出部切除加输尿管膀胱再吻合术。成人单纯型输尿管膨出 ,可优先考虑内腔镜治疗     

Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys

PURPOSE: We review the long-term outcome of retained ureteral stumps in children undergoing heminephrectomy for nonfunctioning upper pole moieties in duplex kidneys. MATERIALS AND METHODS: The medical records of 50 patients who underwent 50 upper pole heminephrectomies for a nonfunctioning upper pole moiety of a duplex kidney between January 1990 and December 2000 were reviewed retrospectively. RESULTS: Median patient age at heminephrectomy was 2.5 years (range 3 weeks to 16.5 years) and median followup was 6 years (range 1 to 11). Indications for heminephrectomy in the 50 renal units were obstructive ureterocele in 25 (50%) cases, ectopic ureter in 15 (30%), obstructive megaloureter in 5 (10%) and reflux nephropathy in 5 (10%). A total of 48 (96%) of the corresponding ureters were taken down as low as possible and transfixed through the heminephrectomy incision. Residual stump excision was required in 5 (10%) of the 50 units for recurrent urinary tract infection due to vesicoureteral reflux. CONCLUSIONS: Our long-term followup suggests that the majority of patients with residual ureteral stumps after upper pole heminephrectomy do not require stump resection.     

MANAGEMENT OF ECTOPIC URETEROCELE ASSOCIATED WITH RENAL DUPLICATION: A COMPARISON OF PARTIAL NEPHRECTOMY AND ENDOSCOPIC DECOMPRESSION

PURPOSE: We compared the efficacy of primary endoscopic decompression versus partial nephrectomy for treating ectopic duplex ureteroceles. MATERIALS AND METHODS: We retrospectively reviewed the records of patients with renal duplication and upper pole ectopic ureterocele. Patients were classified according to the initial radiological evaluation. The operation performed was arbitrarily chosen by the surgeon. RESULTS: A total of 54 patients had unilateral upper or bilateral upper pole ureterocele with no associated vesicoureteral reflux. Partial nephrectomy was performed in 26 patients, of whom 4 (15%) required additional surgery for new onset ipsilateral lower pole reflux. Endoscopic decompression was performed in 28 patients, of whom 18 (64%) required additional treatment due to reflux into the ipsilateral lower pole ureter and ureterocele in 9, reflux into the ureterocele only in 4, ipsilateral lower pole reflux only in 3 and persistent ureterocele obstruction in 2 (p<0.01). An ectopic ureterocele with vesicoureteral reflux into 1 or more moieties was identified in 111 patients, including 56 of 67 (84%) treated with partial nephrectomy and 37 of 44 (84%) treated with endoscopy who have persistent reflux or required further surgery for reflux resolution. CONCLUSIONS: In patients with an ectopic ureterocele and no vesicoureteral reflux partial nephrectomy should be considered the treatment of choice. However, when the initial cystogram reveals vesicoureteral reflux, partial nephrectomy and endoscopic ureterocele decompression have identical definitive cure rates of only 16%. The majority of the latter patients require continued observation and/or additional surgery for managing persistent reflux.     

Clinical value of primary decompression operation for unilateral ureterocele with complete duplex system

PURPOSE: To assess a value of decompression operation for a unilateral ureterocele with a complete duplex system as an initial procedure. METHODS: We reviewed records of 33 pediatric patients with a unilateral ureterocele in a complete duplex system who underwent decompression operation between 1987 and 2000. We checked the patient operative age, followup period, position of the ureterocele, type of decompression operation, and additional operation. Furthermore we also checked postoperative vesicoureteral reflux (VUR) in patients who underwent transurethral incision (TUI). RESULTS: Mean operative age and followup period were 6 months old and 82 months. Of the patients, 22 underwent TUI and 11 underwent upper moiety operation (UMO). In the TUI group, 14 (63.6%) had postoperative VUR and 13 (59.0%) underwent additional operations. These rates were higher in the patients with ectopic ureteroceles than with intravesical ureteroceles. Most additional operations were undergone for the patients with postoperative VUR in TUI group by lower complete reconstructions without UMO. All patients with non-functioning upper moiety underwent heminephrectomy at the additional operations. In the other hand, in the UMO group, 3 (27.3%) had additional operation because of persistent VUR which was found preoperatively in lower moiety or contralateral renal unit. CONCLUSION: TUI was useful approach as an initial procedure for intravesical ureteroceles because of low additional operation rate. For ectopic ureteroceles with functioning upper moiety, TUI was high additional operation rate, but it was more useful initial operation of two-staged operation than UMO because of avoiding UMO, like heminephrectomy, at additional operation. UMO was low additional operation rate for ectopic ureteroceles without preoperative VUR of renal unit excluding upper moiety. Especially heminephrectomy was a useful approach as an initial procedure if upper moiety was non-functioning.     

Long-term outcome of the retained ureteral stump after lower pole heminephrectomy in duplex kidneys

OBJECTIVES: Duplication of the ureter and renal pelvis is the most common upper urinary tract anomaly in childhood. The anatomical and functional divisions between upper and lower moieties of duplex kidney are extremely variable. The underlying pathological condition associated with a lower moiety is usually massive vesicoureteral reflux (VUR) to the lower collecting system and only rare obstruction. The non-functioning upper moiety is usually associated with obstructive ectopic ureter (with or without ureterocele). Most lower pole heminephrectomies are carried out for non-functioning lower moieties. In most cases, the lower defunctionalised segment of the ureter is left in situ. Complete ureterectomy is usually performed if presence of VUR into the lower end of the corresponding ureter is shown. There is little information on the long-term outcome of residual ureteral 'stumps'. The purpose of our study was to review the long-term outcome of retained ureteral stumps in children undergoing heminephrectomy for non-functioning lower pole moieties in duplex kidneys. MATERIALS AND METHODS: The medical records of 19 patients who underwent 20 lower pole heminephrectomies for a non-functioning lower pole moiety of a duplex kidney between January 1990 and December 2000 were reviewed retrospectively. Median age at heminephrectomy was 4.5 years (range: 1 month to 12 years). Indications for heminephrectomy in the 20 renal units was reflux nephropathy in 16 (80%) and obstructive nephropathy in 4 (20%). All corresponding ureters were taken down as low as possible and transfixed through the heminephrectomy incision. Median follow-up was 8.5 years (range: 1-11 years). RESULTS: Eight (40%) showed VUR into the stump after lower pole heminephrectomy. Two of these underwent subureteral endoscopic correction of VUR with polytetrafluoroethylene paste and resection of the stump was carried out in remaining two patients for recurrent urinary tract infections (UTI). Remaining four of the eight patients demonstrated spontaneous resolution of VUR during follow-up. CONCLUSIONS: Our data suggest that the vast majority of patients with residual ureteral stumps after lower pole heminephrectomy do not require stump resection at long-term follow-up.     

Common sheath reimplantation with ureteral plication: A useful technique for the management of ectopic ureterocele

BACKGROUND: When salvaging the upper pole kidney in duplex ectopic ureterocele, primary bladder level surgery with common sheath ureteral reimplantation has the definite advantage of allowing the reconstruction of the entire collecting system through a single lower abdominal incision. However, there are several complications associated with a common sheath reimplantation in a child with a very dilated upper pole ureter, such as vesicoureteral reflux or ureterovesical stenosis. METHODS/RESULTS: To avoid these complications, ureteral plication over the common ureteral sheath in two children with duplex ectopic ureterocele was used. Postoperatively, neither child showed reflux or recurrent urinary tract infection and both showed a marked improvement of the upper pole collecting system. CONCLUSION: This technique allows for a simple and definitive reconstruction in cases of duplex ectopic ureterocele, particularly with dilated upper pole ureter.     

The modern endoscopic approach to ureterocele

PURPOSE: During the last 20 years the surgical approach to ureterocele has evolved from major open surgery to minimally invasive endoscopic puncture. We believe that the endoscopic approach decreases the need for open surgical procedures. We identified specific factors that predict the need for repeat surgery. MATERIALS AND METHODS: We reviewed the charts of 60 new patients with ureterocele treated with primary endoscopic incision between 1991 and 1995. Followup ranged from 4 to 62 months (mean 20). Mode of presentation, ureterocele location, associated vesicoureteral reflux and association of the ureterocele with a duplex system were evaluated. Ureterocele wall thickness was assessed subjectively via radiographic and cystoscopic methods, and categorized as thin, intermediate and thick. RESULTS: All 9 patients with a single system ureterocele had an intravesical ureterocele. No patient had associated reflux nor did any require a secondary open procedure. In 3 cases new onset ipsilateral reflux into the ureterocele spontaneously resolved. Of the 51 patients with a duplex system and associated ureterocele 19 (37%) required a secondary open procedure. The ureterocele was intravesical and ectopic in 22 (43%) and 29 (57%) cases, respectively. Reflux was associated with the ureterocele in 27 patients (53%), and 12 (44%) required a secondary open procedure. A total of 11 patients underwent ureteral reimplantation of 15 refluxing renal units and only 2 renal units required ureteral tapering. Reflux is no longer present in 14 of the 15 renal units (93%). Patients with a thick walled ureterocele required repeat puncture more frequently than those with a nonthick ureterocele. CONCLUSIONS: With the use of modern endoscopic techniques children with intravesical and single system ureteroceles require secondary open surgery less frequently than those with ectopic and duplex system ureteroceles. The mode of presentation does not predict the need for a repeat open procedure. Thick walled ureteroceles require repeat endoscopic puncture more frequently than thin and intermediate walled ureteroceles.     

Endoscopic puncture of ureterocele as a minimally invasive and effective long-term procedure in children

OBJECTIVES: Over the past years the surgical approach to ureterocele has evolved from complicated major surgery to minimally invasive endoscopic treatment. Because of the high rate of secondary surgery in some recently reported series, an upper pole partial nephrectomy is again recommended as the procedure of choice. We have retrospectively evaluated the long-term results of endoscopic puncture of a ureterocele and its long-term effectiveness and applicability in children. METHODS: Over the past 8 years, 34 patients (20 female, 14 male) were treated in our service with primary endoscopic puncture of a ureterocele. The mean age of the patients was 1.1 +/- 4.3 (mean +/- SD) years. Mean follow-up was 6.1 +/- 2.4 years. Antenatally ultrasound detected the ureterocele in 5 (14%) patients, fetal hydronephrosis leading to the postnatal diagnosis in 13 (38%), and 16 (48%) children presented with symptoms of urinary tract infection (UTI). The ureteroceles presented as part of renal duplication in 31 patients (91%), 3 (9%) in a single system and 1 child had bilateral ureteroceles of a duplex system. Twenty (58%) children had intravesical ureteroceles and the remaining 14 (42%) ectopic ureteroceles. Very poorly functioning upper pole moiety presented in 26 (75%) of the cases and nonfunctioning upper poles in 5 (14%). Twenty of 34 children (58%) had initial vesicoureteral reflux (VUR) to the lower moiety, either to the ipsi (60%) or contralateral kidney (40%). A cold knife incision was carried out in 4 (11.7%), puncture by a 3-french Bugbee electrode in 20 (58%), and the stylet of a 3-french ureteral catheter was utilized to puncture the ureterocele in the remaining 10 patients (30.3%). RESULTS: Complete decompression of the ureterocele was observed in 32 of 34 children (94%). Two patients required secondary puncture 2 years following the primary procedure and are doing well. Upper pole moiety function improved postoperatively in 2 infants and remained stable in all 32 patients, no patient presented with deterioration of the renal function. Six of 20 (30%) patients who had initial VUR to the lower pole, accompanied with recurrent UTI, required surgery. Three underwent ureteric reimplantation and another 3 submucosal polytetrafluoroethylene paste (Teflon) injection. Eight (40%) patients presented with spontaneous resolution of VUR to the lower moiety following puncture of the ureterocele. An additional 6 (17.6%) patients developed VUR to the upper moiety following the puncture of the ureterocele, 3 after cold knife incision and 3 after simple puncture. In 2, submucosal Teflon injection solved the VUR and the remaining 4 patients were maintained on prophylactic antibiotics. In 1 child the reflux resolved spontaneously, and none of them presented with UTI. In 2 cases with nonfunctional upper poles, partial nephrectomy was performed due to symptomatic UTI in spite of complete collapse of the ureterocele 1 and 2 years, respectively, following the initial puncture. No difference was observed in the re-operation rate between the patients with ectopic versus intravesical ureterocele (p<0.05). CONCLUSION: We found that endoscopic puncture of a ureterocele presents an easily performed procedure which allows the release of obstructive ureters and avoids major surgery in the majority of the cases even after a long follow-up.     

Surgical management of duplex ureteroceles.

We reviewed the cases of 95 children with duplex ureteroceles treated in this department over an 18-year period. There were 101 ureteroceles (6 bilateral). Diagnosis and treatment were analyzed. Special attention was paid to newborns screened in utero. We always strove to preserve functional renal tissue whenever possible. In keeping with this goal, three surgical techniques were used: (1) upper pole heminephrectomy; (2) ureterocele excision, bladder neck reconstruction, and ureter reimplantation with or without cutaneous ureterostomy of the upper pole ureter; and (3) endoscopic ureterocele incision. Follow-up studies using x-ray and radionuclide imaging demonstrated satisfactory renal function in 86.6% of patients. These findings support a conservative approach to ureteroceles using endoscopic ureterocele incision as the primary treatment. Lower urinary tract reconstruction may be associated in cases involving urinary tract infection, obstruction or incontinence. Upper pole heminephrectomy should be performed only after functional evaluation following ureterocele incision or cutaneous ureterostomy.     

Surgical correction of ureteroceles in childhood

Ureteroceles can present complex problems, but appropriate reconstructive surgery can abolish urinary infection in nearly all cases. It does not suffice to resect or unroof a ureterocele, for this creates vesicoureteral reflux. Instead, for small ureteroceles, total resection by open technique should be carried out, together with reimplantation of the ureter. In large ureteroceles, usually with duplex kidney, removal of the ureterocele and its associated ureter, reimplantation of the ipsilateral ureter, and sometimes the contralateral ureter, should be performed. The associated upper pole renal segment should be removed in most instances; occasionally it can be saved, anastomosing it to the adjacent lower pole renal pelvis. Although management of an individual case must vary with anatomy, age of the patient, etc., the fundamental goals remain identical in all cases: relief of obstruction, removal of destroyed renal segments, and surgical correction of vesicoureteral reflux.     

Ipsilateral ureteroureterostomy for the treatment of vesicoureteral reflux or obstruction associated with complete ureteral duplication

PURPOSE: We reviewed our experience with ureteroureterostomy as definitive treatment for vesicoureteral reflux or obstruction associated with ureteral duplication to determine the efficacy and morbidity of this procedure and identify factors that affect outcome. MATERIALS AND METHODS: We performed a total of 100 ureteroureterostomies in 94 children with an average age of 28 months during the 23-year period ending May 1999. Four patients (4 kidneys) failed to return for postoperative evaluation. Followup was 2.5 to 206 months (mean 33). Indications for surgery were vesicoureteral reflux in 53 cases, obstructing ureterocele in 19, ureterocele with upper pole reflux in 4, an ectopic obstructed upper pole ureter in 18 and other in 2. In 23 kidneys ureteroureterostomy was combined with reimplantation of the recipient ureter. Surgery was considered successful when postoperative imaging revealed no reflux or obstruction and a patent ureteroureterostomy anastomosis. RESULTS: Ureteroureterostomy with or without ureteroneocystostomy was successful for treating 94% of kidneys, including 51 of 53 with reflux, 21 of 23 (91%) with ureterocele and 17 of 18 (94%) with an ectopic obstructed upper pole ureter. Significant ureteral size disparity, defined as a donor ureter diameter greater than 2-fold that of the recipient ureter, was noted in 69 kidneys. The most common complication (13 patients) was prolonged output from the Penrose drain. However, this complication did not result in a failed procedure in any case. CONCLUSIONS: Ipsilateral ureteroureterostomy is safe and efficacious for treating abnormalities associated with ureteral duplication. A significant discrepancy in ureteral size does not preclude ureteroureterostomy.