Wang Hao,Gui Meng,He Qingbao,et al.Clinical outcomes of pneumovesicoscopic ureteral reimplantation for ureterovesical junction obstruction in young infants aged under 6 months[J].Journal of Clinical Pediatric Surgery,,():371-376.[doi:10.3760/cma.j.cn101785-20251124-00085]
Clinical outcomes of pneumovesicoscopic ureteral reimplantation for ureterovesical junction obstruction in young infants aged under 6 months
- Keywords:
- Ureteral Obstruction; Ureterovesical Junction Obstruction; Infant; Mini-invasive Surgical Procedures; Pneumovesicoscopic Ureteral Reimplantation
- Abstract:
- Objective To evaluate the safety and efficacy of pneumovesicoscopic ureteral reimplantation for ureterovesical junction obstruction (UVJO,also known as primary nonrefluxing megaureter) in young infants aged <6 month.Methods A single-center retrospective cohort study was conducted for 77 UVJO children from January 2019 to December 2023.They were assigned into two groups of young infant (<6 month,n=19) and older infant (≥6 month,n=58).The subjects were strictly selected according to predefined high-risk surgical criteria[≥2 of the following: ureteral diameter ≥7 mm with anteroposterior diameter (APD) ≥15 mm,recurrent febrile urinary tract infections ≥2 episodes,radiologic progression >20% within 3-6 months,failure of conservative management for ≥3 month or renal cortical thinning <3 mm/differential renal function <40%].Perioperative parameters,complications and follow-up outcomes were compared.Results All surgical procedures were completed successfully.Intraoperative gas leakage was higher in young infants (36.8% vs.13.8%,P=0.028).However,it was managed by additional Trocar placement.Complication rates were similar (10.5% vs. 8.6%,P=0.675).During a follow-up period of 19.4±8.2 month,both groups demonstrated significant improvements in renal pelvis diameter and ureteral diameter (P<0.001).In the young infant group,APD declined from (21.21±10.93) to (8.95±4.21) mm while ureteral diameter dropped from (17.79±5.16) to (7.42±2.68) mm.Overall radiographic improvement rate,based upon predefined ultrasound criteria,was 96.1%(74/77).Three children (3.9%) experienced recurrent urinary tract infections during follow-up. Conclusions Under strict indications and experienced surgeons,pneumovesicoscopic ureteral reimplantation for UVJO is both safe and feasible for young high-risk infants.Their perioperative safety and medium-term radiographic outcomes are comparable to older children.This study provides preliminary radiographic rationales for early surgical interventions in selected young high-risk infants.Further studies with functional endpoints are required for validating long-term renal outcomes.
References:
[1] 中华医学会小儿外科学分会小儿泌尿外科学组.儿童原发性梗阻性巨输尿管症诊疗专家共识[J].中华小儿外科杂志, 2022, 43(8):679-684.DOI:10.3760/cma.j.cn421158-20220402-00233. The Group of Urology, the Society of Pediatric Surgery, Chinese Medical Association.Expert consensus on the diagnosis and treatment of Primary Obstructed Megaureters in children[J].Chin J Pediatr Surg, 2022, 43(8):679-684.DOI:10.3760/cma.j.cn421158-20220402-00233.
[2] Di Renzo D, Aguiar L, Cascini V, et al.Long-term followup of primary nonrefluxing megaureter[J].J Urol, 2013, 190(3):1021-1026.DOI:10.1016/j.juro.2013.03.008.
[3] Yeung CK, Sihoe JDY, Borzi PA.Endoscopic cross-trigonal ureteral reimplantation under carbon dioxide bladder insufflation: a novel technique[J].J Endourol, 2005, 19(3):295-299.DOI:10.1089/end.2005.19.295.
[4] Jude E, Deshpande A, Barker A, et al.Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age[J].J Pediatr Urol, 2017, 13(1):47.e1-47.e7.DOI:10.1016/j.jpurol.2016.09.009.
[5] Chung KLY, Sihoe J, Liu K, et al.Surgical outcome analysis of pneumovesicoscopic ureteral reimplantation and endoscopic dextranomer/hyaluronic acid injection for primary vesicoureteral reflux in children: a multicenter 12-year review[J].J Laparoendosc Adv Surg Tech A, 2018, 28(3):348-353.DOI:10.1089/lap.2017.0281.
[6] Baek M, Han DH.Transvesicoscopic Politano-Leadbetter ureteral reimplantation in children with vesicoureteral reflux: a novel surgical technique[J].Investig Clin Urol, 2019, 60(5):405-411.DOI:10.4111/icu.2019.60.5.405.
[7] Bujons A, Salda?a L, Caffaratti J, et al.Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up?[J].J Pediatr Urol, 2015, 11(1):37.e1-37.e6.DOI:10.1016/j.jpurol.2014.09.005.
[8] Ortiz R, Parente A, Perez-Egido L, et al.Long-term outcomes in primary obstructive megaureter treated by endoscopic balloon dilation.experience after 100 cases[J].Front Pediatr, 2018, 6:275.DOI:10.3389/fped.2018.00275.
[9] Soh S, Kobori Y, Shin T, et al.Transvesicoscopic ureteral reimplantation: Politano-Leadbetter versus Cohen technique[J].Int J Urol, 2015, 22(4):394-399.DOI:10.1111/iju.12702.
[10] Isac GV, Ionescu NS.Endoscopic balloon dilation for primary obstructive megaureter in children: early outcomes and complications-a case series[J].Medicina (Kaunas), 2025, 61(3):479.DOI:10.3390/medicina61030479.
Memo
收稿日期:2025-11-24。
通讯作者:张磊,Email:zhangyiyuok@126.com