Effectiveness of primary endoscopic incision of ureteroceles

Endoscopic incision of a ureterocele (EIU) is simple when compared to an open procedure such as ureterocele excision with or without an upper-pole nephrectomy. It has, however, the potential to induce vesicoureteric reflux (VUR), which traditionally requires further surgical intervention. The natural history of the VUR that develops following EIU is not known. We have treated asymptomatic VUR that developed following EIU conservatively and have surgically intervened only in cases with recurrent urinary tract infections (UTI). This is a review from a single surgeon's practice involving 29 consecutive cases of ureterocele spread over a period of 4 years. The range of follow up was 4–54 months (median 32). Of the 24 children who underwent primary EIU, 6 required a second procedure, 3 a reincision and 3 an open procedure. Of the 3 who had a reincision, 2 required a further open procedure. The indication for reincision was failure of decompression of the upper tract and the indication for an open procedure was recurrent UTI following EIU. Thus, overall success was achieved in 19 of 24 cases of primary EIU (79.2%). VUR following EIU appeared in 10 cases (41%); UTI developed in only 5 (50%) of these 10 cases. Overall, UTI developed in 6 of the 24 (25%) cases of primary EIU. Eight children had an open procedure (3 as a primary procedure and 5 after EIU); 2 (25%) from this group had UTI following the procedure, and interestingly, neither had VUR. Ureterocele incision is thus a good alternative to upper-pole nephrectomy or excision of the ureterocele, especially in infancy. There is an inherent risk of producing VUR in the postincision period, however, the majority of cases can be managed conservatively. All patients need to be monitored for hypertension and UTI following EIU. Accepted: 17 October 2000     

输尿管囊肿30例的诊断和治疗

目的探讨输尿管囊肿的诊断和治疗。方法综合分析30例输尿管囊肿患者的临床资料,术前均由B超、静脉肾盂造影(IVP)或膀胱镜确诊。15例行经尿道囊肿低位横切开术,15例行囊肿切除+输尿管再植术(成形术)。结果 30例患者均获痊愈,随访1个月至6年,无输尿管囊肿复发及并发症的发生。结论多种检查方法对输尿管囊肿均具有较高的诊断价值,经尿道输尿管囊肿的腔内手术疗效显著,应为首选治疗方法。     

经尿道内腔镜治疗输尿管囊肿(附15例报告)

目的：探讨输尿管囊肿的诊断和经尿道输尿管囊肿内镜下治疗方法。方法：15例患者均于术前明确诊断，其中膀胱镜诊断准确率100．0％、IVU诊断率80％、B超诊断率83．3％，均行经尿道输尿管囊肿内镜下切开或去顶术。结果：平均手术时间64．5min，术后平均住院3．5d，其中3例门诊治疗，未住院。术后平均随访16．5个月，效果良好，未见返流发生。结论：B超结合IVU、膀胱镜检查可以提高确诊率。输尿管囊肿治疗以经尿道输尿管囊肿切开或去顶术可以减少手术创伤及术后并发症，缩短手术及住院时间，可以作为输尿管囊肿的首选治疗方法。     

Prenatal complicated duplex collecting system and ureterocele—Important risk factors for urinary tract infection

Purpose

To evaluate the risk of urinary tract infections (UTIs) in infants with prenatally detected complicated duplex collecting system (CDS) or ureterocele.

输尿管囊肿的诊断与治疗

目的探讨输尿管囊肿的诊断与治疗方法。方法回顾性分析范县人民医院2000年至2008年收治的17例输尿管囊肿病例资料。其中15例经尿道内镜下囊肿切开或部分切除术,1例行耻骨上经膀胱囊肿切除、输尿管再植术,1例行上位肾输尿管切除术。结果手术均一次成功,随访2～4年囊肿无复发,临床症状消失,无输尿管反流。结论经尿道内镜下囊肿切开术是治疗成人输尿管囊肿的一种安全、有效、创伤小、恢复快的方法。当囊肿直径>3cm或者合并重复肾、输尿管畸形时,应采用开放手术切除囊肿,行抗反流手术。     

Ureteroceles in infancy and childhood: in search of the correct surgical approach

Between 1967 and 1986, 61 patients with 63 ureteroceles were treated; 53 ureteroceles were associated with duplex, 10 with single collecting systems. Antenatal and postnatal presentation and the means and limits of the possible investigations (intravenous urography, ultrasound, cystoscopy, micturition cystogram, isotope renography) are discussed. Thirty-nine ureteroceles were enucleated either with or without ureteric reimplantation. In patients with duplex systems this procedure was followed by heminephroureterectomy. The operative technique of the enucleation is discussed and the pros and cons of urinary diversion are mentioned. Eight ureteroceles were treated by primary heminephroureterectomy only, however in 75% secondary enucleation or ureteric reimplantation to stop reflux and infection became necessary; 12.5% developed a diverticulum. The remaining 16 ureteroceles were mainly treated unroofing or incision. The overall long-term results regarding reflux, urinary-tract infectios, and continence were excellent; in the majority of cases this was only after full reconstruction of the lower urinary tract. The function of the renal units involved remained constant or improved in 82% of the cases. We are aware that the enucleation procedure is a technically very demanding and time-consuming operation, nevertheless we highly recommend it, as it follows the principle and philosophy of surgical correction, achieving results as near normality as possible.     

产前超声诊断重复肾畸形及误诊原因分析

目的 探讨胎儿重复肾畸形的产前超声声像图特征,分析误诊原因。 方法 对2007年1月—2010年6月经产前超声诊断的27胎重复肾胎儿的声像图特点与临床资料进行回顾性分析。 结果 产前超声诊断胎儿重复肾27胎,21胎为单侧重复肾,4胎为双侧重复肾,共29侧重复肾;其中12侧合并输尿管扩张,5侧合并输尿管囊肿。4胎合并其他系统器官畸形。产前超声误诊3胎,其中1胎产前诊断为左侧重复肾,出生后复查左肾未见明显异常;1胎产前诊断右侧重复肾,出生后复查为右侧肾上腺血肿;1胎产前诊断为左肾积水合并输尿管扩张,出生后复查为左侧重复肾。 结论 两个不相通的肾盂是胎儿重复肾的主要声像图特征;超声对于中、晚孕期诊断胎儿重复肾有重要的价值。     

超声诊断输尿管囊肿

输尿管囊肿是一种先天性输尿管末端发育异常性疾病,多见于小儿,偶见于成年人.本文回顾性分析14例成人输尿管囊肿的超声图像及常见漏诊误诊原因.