科研之友
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摘要
Purpose. Totally endoscopic management (all-endo) of patients with a duplicated renal system (DS) associated with severe vesicoureteral reflux (VUR) or obstructive ureterocele (UC) is an attractive alternative to traditional open procedures. The authors discuss feasibility and results of an all-endo approach on a consecutive series of patients. Methods. From 1999 to 2009, all patients with a complete DS associated with UC and/or VUR were proposed for primary all-endo approach. UC puncture was performed using a 3ˋFr Bugbee electrode. Deflux (dextranomer/hyaluronic acid copolymer) injection was administered for VUR. The need for secondary surgery was evaluated on followup. Results. Of the 62 patients recruited, 46 were treated using a primary all-endo approach and 16 patients received no treatment. Of the 46 treated patients with 56 affected renal units, 32 (97%) UCs collapsed following puncture and 29 (63%) VURs were resolved or downgraded. Secondary VUR occurred in 13 (39%) renal units. Secondary surgery was performed on 23 (41%) renal units. Conclusion. The all-endo approach for VUR in DS is an effective therapeutic option. UC collapse was achieved by puncture in most of the patients; secondary VUR was the main complication in a small group of extravesical UC. 1. Introduction There is wide debate on the management of patients with a complete duplicated pyeloureteral system (DS) associated with ureterocele (UC) and/or major vesicoureteral reflux (VUR), and consensus on this matter has not yet been reached [1每5]. This may be due to the wide spectrum of anatomical and clinical features observed in affected patients and the need for an individualized approach. As far as the endoscopic approach to treatment is concerned, the use of UC puncture to relieve obstruction, control infection, and recover renal function is hampered by controversial outcomes and side effects [6]. Secondary VUR and the need for subsequent intravesical surgery have been reported by several studies [6, 7]. In contrast, a conservative approach to the treatment of certain types of UC has been gaining favour [3]. Treatment of VUR associated with a duplex pyeloureteral system, with or without concomitant UC, is another matter for debate. Endoscopic intrameatal injection of bulking agents was reported to be less effective than in a single system when used to treat VUR [8]. During the last decade, the treatment policy at our institution has been to consider minimally invasive all-endo management as the primary option for this group of urinary tract anomalies. The aim of our study was to
- 出版日期2011
