Zhu Guodong,Liu Xingjian,Li Aiwu.Comparative efficacy analysis of pneumovesical modified nipple versus Cohen ureteral reimplantation for infantile primary obstructed megaureter[J].Journal of Clinical Pediatric Surgery,,():365-370.[doi:10.3760/cma.j.cn101785-20251030-00028]
Comparative efficacy analysis of pneumovesical modified nipple versus Cohen ureteral reimplantation for infantile primary obstructed megaureter
- Keywords:
- Megaloureter; Infant; Laparoscopy; Ureteral Reimplantation; Therapeutic Effect; Retrospective Study
- Abstract:
- Objective To compare the clinical outcomes and safety of pneumovesical modified nipple ureteral reimplantation versus pneumovesical Cohen ureteral reimplantation for primary obstructed megaureter (POM) in infants.Methods For this retrospective cohort study,the relevant clinical data were retrospectively reviewed for 56 POM infants from January 2015 to October 2024.According to specific surgical approaches,they were assigned into two groups of Cohen (n=27) and modified nipple (n=29).Operative duration,intraoperative volume of blood loss,duration of postoperative hematuria,length of postoperative hospitalization stay,complication rates and postoperative ultrasonic parameters (ureteral diameter,anteroposterior pelvic diameter & renal cortical thickness) were compared between two groups.Results Two cases in Cohen group required intraoperative conversion into open surgery while no conversion occurred in modified nipple group.Operative duration[(97.93±12.14) vs.(125.59±14.50)min],duration of postoperative hematuria[(2.10±1.08) vs.(2.74±1.02)day]and length of hospitalization stay[(9.45±2.26) vs.(12.04±4.47)day]were all significantly shorter in modified nipple group than those in Cohen group (all P<0.05).Intraoperative volume of blood loss and hospitalization expenses did not differ markedly between two groups (P>0.05).Over a follow-up period of 13 months to 9 years,ureteral diameter was smaller in modified nipple group than that in Cohen group[(0.58±0.17) vs.(0.71±0.19)cm,P<0.05]while other ultrasonographic parameters showed no significant between-group differences (P>0.05).Febrile urinary tract infection occurred during stenting in modified nipple group (n=2) and Cohen group (n=3); all improved with antibiotic therapy and did not recur after stent removal.In Cohen group,voiding cystourethrography (VCUG) at 3 months postoperatively revealed grade I vesicoureteral reflux (VUR) without symptoms (n=1).It self-resolved after 1-year follow-up.In modified nipple group,one case of grade Ⅱ VUR was identified at 6 months postoperatively without clinical symptoms disappeared after 10-month follow-up.Conclusions Both ureteral reimplantation techniques are efficacious for infantile POM.Pneumovesical modified nipple ureteral reimplantation,with its relatively simple procedure,minimal trauma and faster recovery,better aligns with the physiological characteristics of infantile bladder,making it a preferred surgical approach for infantile POM.
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Memo
收稿日期:2025-10-30。
基金项目:山东省齐鲁医学院发展基金(34641390220001)
通讯作者:李爱武,Email:liaiwu@qiluhospital.com