[Occupied ureterocele and incomplete double collecting system.]

El ureterocele es una dilatación quística del extremo intravesical del uréter. Una de las teorías más aceptadas para su formación...

[CLINICAL EXPERIENCE IN DIAGNOSIS AND MANAGEMENT OF COMPLETE DUPLICATION OF KIDNEY AND URETER IN 106 CHILDREN]

OBJECTIVE

To discuss the clinical classification and treatment protocols of complete duplication of kidney and ureter in children.

METHODS

Between March 2000 and February 2015, 106 children with complete duplication of kidney and ureter were treated, and the clinical data were retrospectively analyzed. Of them, there were 11 boys and 95 girls, aged from 1 month to 11 years (mean, 3.5 years); one side was involved in 88 cases and two sides in 18 cases. They were divided into 4 types according to image examinations and clinical presentations: 14 patients who needed no special treatment were classified into the first type, 15 patients who underwent reconstruction into the second type, 74 patients who underwent segment removal of renal dysplasia and subtotal excision of abnormal duplicated ureter into the third type, and 3 patients who underwent removal of the whole affected kidney and subtotal excision of whole ureter into the forth type.

RESULTS

The patients were followed up 2 months to 14 years (median, 23 months). There was no deteriorating case in the first type. There was no complication such as leakage of urine, discomfort over the back and loins, ureterocele, reproductive tract infection, or hematuresis in the other types. The results of white blood cell count, renal function, and electrolyte presented no abnormality. One patient in the second type and 6 patients in the third type had ureteral stump syndrome; 1 patient in the second type and 3 patients in the third type had urinary tract infection; and 3 patients in the second type had mild hydronephrosis after operation.

CONCLUSION

It can obtain good clinical outcome to choose individualized treatment according to clinical classification of complete duplication of kidney and ureter, which can reserve effective renal units as much as possible and improves the patients' quality of life.

[Effect of prophylactic intravesical instillation of pirarubicin to prevent recurrent bladder tumors following nephroureterectomy for upper urinary tract cancer]

We retrospectively evaluated 23 patients who had been administered pirarubicin by intravesical instillation once weekly for 5 weeks, after undergoing surgery for upper urinary tract cancer between May 2003 and October 2008. We compared their clinical records with those of 19 patients with upper urinary tract cancer subjected to nephroureterectomy between 1998 and 2008, and who did not receive intravesical instillation of pirarubicin. This prophylactic therapy was well tolerated and contributed to reduce the rate of bladder recurrence. The non-recurrence rate at 2 years was 87.0% in the instillation group and 68.4% in the non-instillation group (P＝0.0025). The overall analysis of the study population did not reveal any statistically significant risk factors of bladder recurrence.

Endoscopic and minimal open surgical incision of ureteroceles

Ureterocele decompression by endoscopic or open incision was the primary treatment in 59 children with 63 ureteroceles. Of these, 18 were intravesical and 45 were ectopic. The endoscopic or open incision adequately decompressed all intravesical ureteroceles and 37 of 45 ectopic ureteroceles (82%). After incision, the secondary operation rate was 17% for intravesical and 62% for ectopic ureteroceles. In our opinion, endoscopic or open incision must be considered a definitive treatment in the large majority of intravesical ureteroceles and is also valid in ectopic ureteroceles. In these cases, the early decompression obtained by this approach produced significant functional recovery, fewer urinary tract infections, and facilitated subsequent surgery in those patients requiring complete surgical reconstruction.

Obstructive uropathy in the newborn

The three common causes of urinary obstruction in the newborn are ureteropelvic obstruction, posterior urethral valves, and ureteroceles. Considerable controversy exists regarding their embryology and treatment, yet the basic principles are clear and consist of relief of urinary obstruction, prevention of infection, and maintenance of renal function. Subsequently, total reconstruction can be implemented.

Suggested terminology for duplex systems, ectopic ureters and ureteroceles

Recommendations are made for the standardization of nomenclature describing duplex systems, ectopic ureters and ureteroceles. The elimination of some terms and redefinition of others are proposed in the hope to eliminate the ambiguity and confusion that exist currently.

Ectopic ureterocele

Images