经尿道腔镜下囊肿内切开术治疗单纯输尿管囊肿

目的探讨经尿道腔镜下囊肿内切开术治疗单纯输尿管囊肿的疗效。方法回顾总结12例行经尿道输尿管囊肿内切开术治疗的单纯输尿管囊肿患者临床资料，所有患者均经IVP、超声、膀胱镜检查确诊，手术方法包括行囊肿切开术4例及部分囊肿壁切除术8例。结果所有手术均取得成功，无一例转为开放手术，术后随访5～21个月，临床症状消失，肾积水减轻，无膀胱输尿管反流发生。结论经尿道电切术治疗单纯输尿管囊肿，具有创伤小，患者痛苦小，术后恢复快，并发症少等优点，可作为单纯输尿管囊肿治疗的首选方法。     

成人输尿管囊肿11例报告

目的：总结成人输尿管囊肿的诊治经验。方法；对住院手术治疗的１１例本病虱临床资料进行分析。结果：均经Ｂ超，ＩＶＵ及膀胱镜检查确诊。开放手术２例，经尿道输尿管囊肿电切开术９例。１０例获术后随访，疗效确切。结论：对囊肿直径≤３．０ｃｍ者宜行经尿道电切开术，面对直径〉３．０ｃｍ及合并严重的重复肾重复输尿管畸形者应采取开放性手术，并行输尿管再植抗反流。     

Structural features of three ureterocele calculi

Ureterocele calculi are developed in cavities with urinary retention but far from the upper renal cavities. The structural features of three ureterocele calcium oxalate stones were observed by scanning electron microscope coupled with X ray microanalysis. The urinary parameters of the three patients were also determined. The stone A consisted of loose structure of large calcium oxalate dihydrate crystals and small spheres of hydroxyapatite. The interior contains disorganized plate-like calcium oxalate monohydrate crystals. The stone B was formed by a compact outer layer of calcium oxalate monohydrate columnar crystals. The structure of stone interior was similar to the stone A. The stone C was formed by concentric layers composed of either calcium oxalate monohydrate columnar crystals or hydroxyapatite. The core consisted of agglomerated calcium oxalate monohydrate crystals, hydroxyapatite and organic matter. From the urinary biochemical data it was deduced that two ureterocele patients (who formed A and B stones) were hypercalciuric (calcium > 300 mg/24 h), being 6.5 the urinary pH value of the patient that formed the A stone, and 7.0 the urinary pH of the patient that formed the C stone. The rest of urinary parameters for the three patients were normal. Thus, one of the requisite conditions for unattached stone development is the existence of a place inside the urinary tract where the solid particles that act as calculus initiator of the stone can be retained enough time to exert this action.     

Pediatric Ureteroceles: Diagnosis,Management and Treatment Options

Objective

The aim of the study was to evaluate clinical characteristics of ureteroceles particularly for diagnostic and treatment challenges.

Methods

Data about patients treated for ureterocele in the two hospital clinics during 1996- 2009 are retrospectively evaluated.

Findings

There were 12 girls and 7 boys. Symptomatic urinary tract infection was found in twelve cases. Ureterocele was associated with duplex systems in eleven cases. Vesicoureteral reflux was detected in 4 patients. Bladder diverticulum complicated with ureterocele in 1 patient. Ultrasonography diagnosed ureterocele in 12 patients. Renal scarring was detected in 6 patients at the side of ureterocele. Fifteen patients showed varying degrees of hydro-ureteronephrosis. Surgical therapy included upper pole nephrectomy in 3 cases. Bladder level reconstruction was performed in 11 cases. Five patients were treated only by endoscopic incision. In the follow up period 4 patients showed long term urinary tract infections whereas 3 of them were treated endoscopically. Postoperative reflux was still present in two patients who were treated by endoscopic incision.

Conclusion

Ureterocele diagnosis and treatment show challenges. Urinary tract infection is important marker for urinary system evaluation. Preoperative management generally depends on a combination of diagnostic methods. Endoscopic incision needs serious follow up for postoperative problems.     

经尿道输尿管囊壁部分切除术治疗成人输尿管囊肿11例临床分析

目的探讨经尿道输尿管囊壁部分切除术治疗成人输尿管口囊肿的治疗经验。方法回顾性分析11例成人输尿管口囊肿的临床资料。所有患者均采用B超、IVU及膀胱镜检查确诊,采用经尿道输尿管囊壁部分切除术治疗。结果11例患者手术治疗痊愈出院,术后临床症状均消失。随访6--24个月,9例肾积水消失,2例肾积水明显改善,未见复发。结论膀胱镜检查是诊断输尿管囊肿的确切手段;经尿道输尿管囊肿壁部分切除术是一种简便、安全和行之有效的治疗手段。     

Obstructive ureterocele—an ongoing challenge

Ureterocele is a cystic dilatation of the intravesical ureter that is most commonly observed in females and children, and usually affects the upper moiety of a complete pyeloureteral duplication. According to their position, ureteroceles are divided into intravesical, when the ureterocele is completely contained inside the bladder, and extravesical when part of the cyst extends to the urethra or bladder neck. Most ureteroceles are diagnosed in utero or immediately after birth during an echographic screening of renal malformations. Severe, febrile urinary tract infection is the most common postnatal presentation of ureteroceles, but they may, rarely, prolapse and acutely obstruct the bladder outlet. Once an ureterocele is identified sonographically, a voiding cystourethrogram to detect vesicoureteral reflux (VUR) and a 99m-technetium dimercapto-succinic acid renal scan to evaluate the function of the different portions of the kidney are mandatory. VUR in the lower pole is observed in 50% of cases and in the contralateral kidney in 25%. Simple endoscopic puncture of the ureterocele has recently been advocated as an emergency therapy for infected or obstructing ureteroceles and as an elective therapy for intravesical ureteroceles. The rate of additional surgery after elective endoscopic puncture of an orthotopic ureterocele ranges from 7 to 23%. Treatment of ectopic ureteroceles is more challenging and both endoscopic puncture and upper pole partial nephrectomy frequently require additional surgery at the bladder level. The reoperation rate after endoscopic treatment varies from 48 to 100%. It is 15 to 20% after upper pole partial nephrectomy if VUR was absent before the operation, but is as high as 50–100% when VUR was present. Thus, endoscopic incision is appropriate as an emergency treatment or when dealing with a completely intravesical ureterocele. Upper pole partial nephrectomy is the elective treatment for an ectopic ureterocele without preoperative VUR. In an ectopic ureterocele with VUR, no matter which type of primary therapy has been chosen, a secondary procedure at the bladder level, involving ureterocele removal and reimplantation of the ureter(s), should be anticipated.     

Is one-stage ureterocele repair possible in children?

AIM: To determine the long-term results of ureterocele repair, bearing in mind the relative rarity of the malformation, its very polymorphic appearance and the diversity of treatments. MATERIALS AND METHODS: Long-term results were assessed by postoperative follow-up of 126 children with 131 ureteroceles between 1970-2000. RESULTS: With a mean follow-up of 72 months, only 64.2% of children were cured after a one-stage procedure. According to the anatomical type, favourable results were obtained in 81.6% of cases with a single ureter and 57.9% of cases with a duplicated ureter. Treatment success rates for single or duplicated ureters were 73% in the case of intravesical implantation and only 53.9% (34/63 children) in ectopic forms. According to the technique, cure rates were 67.6% after distal incision in 34 children, 61.9% after total nephrectomy or upper pole nephrectomy in 42 children, 50% after ureterocele repair and ureterovesical reimplantation in 20 patients, 75% after total resection of the pathological ureter, parietal reconstruction and ipsilateral and/or contralateral reimplantation in another 20 patients. CONCLUSIONS: A one-stage procedure is only able to cure 2/3 of patients. In view of the tendency to progressive regression of often monstrous distensions during the neonatal period, first-line treatment should consist of a distal incision, followed, in the case of recurrent infections, by partial or total nephrectomy, while reserving the intravesical approach to cases with recurrent pyelonephritis. When this surgery is performed on older children or adolescents, the ureteroceles will be smaller with a lower risk of sphincter damage.     

输尿管口囊肿的内镜切开,开窗术

内镜手术为输尿管口囊肿的治疗开辟了新的途径。该组１０例单纯性输尿管口囊肿经内镜切开，开窗术治疗，效果满意。术后随访，梗阻解除且无膀胱输尿管返流讨论了Ｂ超，排泄性尿路造影和膀胱镜检的诊断价值，并介绍了术中应用利尿剂的体会，提出了内镜操作的要点及预防返流的方法。     

经尿道手术治疗输尿管膨出(附15例报告)

目的：探讨输尿管膨出患者行经尿道手术的治疗经验。方法：对15例输尿管输膨出患者采用经尿道手术治疗的资料进行总结。结果：15例均经IVU、B超、膀胱镜检查确诊,6例行经尿道囊肿低位横行切开术,4例积水消失,2例积水改善;9例行输尿管膨出囊壁部分切除术 ,积水全部消失。结论：输尿管膨出行经尿道手术治疗是一种简单而有效的治疗,经尿道囊壁部分切除术效果更为理想。     

肾及输尿管重复畸形伴输尿管囊肿1例

患者女,36岁."以间断性右下腹痛3个月,加重1个月"入院,既往无肾区绞痛,无尿频、尿急、尿痛及血尿等其他疾患.查体:右肾区压痛及叩击痛.