INTRODUCTION:Transureteroureterostomy (TUU) provides urinary drainage of both renal systems to the bladder via a single ureter and is useful in selected situations of complex urological reconstructions. Herein we discuss its use, advantages and complications in children with neurogenic bladders and high-grade (4/5) reflux who have undergone augmentation cystoplasty. PATIENTS AND METHODS:Children with neurogenic bladder complicated by unilateral or bilateral high-grade vesicoureteric reflux (VUR), who underwent TUU along with augmentation cystoplasty (BA), were selected from two institutions. Eighteen children with an average age of 5 years at presentation were identified from a retrospective chart review. RESULTS:All had bilateral hydroureteronephrosis (HUN) of which there were 30 refluxing megaureters. While BA reduced bladder pressure, VUR was managed by refluxing to non-refluxing TUU in six cases with unilateral VUR and unilateral reimplantation with TUU to the reimplanted ureter in 12 cases of bilateral VUR, thus minimizing reimplantation to 12 of 30 ureters. The average time of follow-up was 51 months. Follow-up cystograms showed complete resolution of VUR in all. HUN improved/stabilized in all but one child. Serum creatinine remained normal in all but two cases. Other advantages of TUU include the use of the distal ureter as a catheterizable channel and ease of undiversion when the ureter has been diverted as a ureterostomy. An unusual complication of a TUU site stricture is discussed and the innovative technique of using a cecal patch to salvage the anastomosis is detailed. CONCLUSION:We conclude that a TUU is a safe and useful adjunctive procedure in children undergoing BA for neurogenic bladder with high-grade VUR, minimizing the need for ureteric reimplant in an unhealthy bladder.

译文

简介:经尿道输尿管造口术(TUU)可通过单个输尿管将两个肾脏系统的尿液引流至膀胱,在某些复杂的泌尿系统重建情况下很有用。在这里,我们讨论了其在接受了扩大性膀胱成形术的神经源性膀胱和高位(4/5)反流的儿童中的使用,优点和并发症。
患者与方法:从两个机构中选择接受TUU并同时行膀胱扩大成形术(BA)的神经源性膀胱并发单侧或双侧高级别膀胱输尿管反流(VUR)的儿童。通过回顾性图表审查确定了18名平均年龄为5岁的儿童就诊。
结果:所有患者均患有双侧输尿管肾盂积水(HUN),其中有30例回流的大输尿管。虽然BA降低了膀胱压力,但在6例单侧VUR的情况下,通过回流至非回流TUU来处理VUR,而在12例双侧VUR的单侧再植入输尿管的情况下,将TUU单侧再植入,从而最大限度地减少了再植入30例输尿管中的12例。平均随访时间为51个月。随访的膀胱造影显示所有VUR均已完全消退。除一名儿童外,所有儿童的HUN均得到改善/稳定。除两例外,其余所有患者的血清肌酐均保持正常。 TUU的其他优点包括将远端输尿管用作可导管插入的通道,当输尿管已被转移为输尿管造口术时,易于转移。讨论了TUU部位狭窄的异常并发症,并详细介绍了使用盲肠贴片修复吻合的创新技术。
结论:我们得出结论,对于接受高级别VUR的神经源性膀胱BA的患儿,TUU是一种安全而有用的辅助手术,可最大程度地减少不健康膀胱中输尿管再植的需要。

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