Chen Jiejun,Guo Yunfei,Huang Liqu.Analysis of the current status of treatment for primary obstructive megaureter in infants[J].Journal of Clinical Pediatric Surgery,,():697-700.[doi:10.3760/cma.j.cn101785-202406014]
Analysis of the current status of treatment for primary obstructive megaureter in infants
- Abstract:
- As a common congenital urological condition,primary obstructive megaureter (POM) is characterized by a ureteral diameter>7 mm outside bladder,starting from the 30th week of pregnancy.It accounts for approximately 23% of urinary tract obstruction in children.Previous studies have indicated that POM has a high spontaneous resolution rate and non-surgical management usually maintains stable kidney function.However,surgical intervention may be required for individuals with clinical symptoms or significantly impaired kidney function.Proper intervention is still widely debated,particularly for infants aged under one year.This review summarized the treatment protocols for POM children aged under one year,focusing upon examining the advantages and disadvantages of different treatments and their outcomes.It offered valuable references for clinicians in developing treatment protocols.
References:
[1] Hodges SJ,Werle D,Mclorie G,et al.Megaureter[J].ScientificWorldJournal,2010,10:603-612.DOI:10.1100/tsw.2010.54.
[2] Rubenwolf P,Herrmann-Nuber J,Schreckenberger M,et al.Primary non-refluxive megaureter in children:single-center experience and follow-up of 212 patients[J].Int Urol Nephrol,2016,48(11):1743-1749.DOI:10.1007/s11255-016-1384-y.
[3] Stehr M,Sch?fer FM.Primary obstructive megaureter:a domain of conservative treatment[J].Aktuelle Urol,2020,51(2):127-131.DOI:10.1055/a-1010-3697.
[4] Holzman SA,Braga LH,Zee RS,et al.Risk of urinary tract infection in patients with hydroureter:an analysis from the Society of Fetal Urology Prenatal Hydronephrosis Registry[J].J Pediatr Urol,2021,17(6):775-781.DOI:10.1016/j.jpurol.2021.09.001.
[5] Arena F,Baldari S,Proietto F,et al.Conservative treatment in primary neonatal megaureter[J].Eur J Pediatr Surg,1998,8(6):347-351.DOI:10.1055/s-2008-1071230.
[6] Gnech M,’t hoen L,Zachou A,et al.Update and summary of the European Association of Urology/European Society of Paediatric Urology Paediatric guidelines on vesicoureteral reflux in children[J].Eur Urol,2024,85(5):433-442.DOI:10.1016/j.eururo.2023.12.005.
[7] Shenoy MU,Rance CH.Is there a place for the insertion of a JJ stent as a temporizing procedure for symptomatic partial congenital vesico-ureteric junction obstruction in infancy?[J].BJU Int,1999,84(4):524-525.DOI:10.1046/j.1464-410x.1999.00256.x.
[8] Farrugia MK,Steinbrecher HA,Malone PS.The utilization of ste-nts in the management of primary obstructive megaureters requiring intervention before 1 year of age[J].J Pediatr Urol,2011,7(2):198-202.DOI:10.1016/j.jpurol.2010.04.015.
[9] Awad K,Woodward MN,Shalaby MS.Long-term outcome of JJ stent insertion for primary obstructive megaureter in children[J].J Pediatr Urol,2019,15(1):66.e1-66.e5.DOI:10.1016/j.jpurol.2018.09.011.
[10] Parente A,Esposito C.Editorial:management of primary obstructive megaureter[J].Front Pediatr,2019,7:365.DOI:10.3389/fped.2019.00365.
[11] Chiarenza SF,Bleve C,Zolpi E,et al.Endoscopic balloon dilatation of primary obstructive megaureter:method standardization and predictive prognostic factors[J].Pediatr Med Chir,2019,41(2):219.DOI:10.4081/pmc.2019.219.
[12] Skott M,Gnech M,’t hoen L,et al.Endoscopic dilatation/incision of primary obstructive megaureter.a systematic review.on behalf of the EAU Paediatric Urology Guidelines Panel[J].J Pediatr Urol,2024,20(1):47-56.DOI:10.1016/j.jpurol.2023.09.005.
[13] 钟量,邹翔宇,孙杰.球囊扩张术治疗原发性梗阻型巨输尿管的可行性研究[J].临床小儿外科杂志,2023,22(2):139-143.DOI:10.3760/cma.j.cn101785-202202018-008. Zhong L,Zou XY,Sun J.Feasibility analysis of balloon dilatation for primary obstructive megaureter[J].J Clin Ped Sur,2023,22(2):139-143.DOI:10.3760/cma.j.cn101785-202202018-008.
[14] Faraj S,Loubersac T,Graveleau A,et al.Postoperative JJ stent is not necessary after balloon high-pressure endoscopic dilatation of primary obstructive megaureter[J].J Pediatr Urol,2022,18(3):369.e1-369.e7.DOI:10.1016/j.jpurol.2022.03.028.
[15] Kajbafzadeh AM,Payabvash S,Salmasi AH,et al.Endoureterotomy for treatment of primary obstructive megaureter in children[J].J Endourol,2007,21(7):743-749.DOI:10.1089/end.2006.0330.
[16] Wein AJ,Kavoussi LR,Partin AW,et al.Campbell-Walsh urology[M].11th ed.Philadelphia:Elsevier,2015:2915,3073.
[17] de Kort LMO,Klijn AJ,Uiterwaal CSPM,et al.Ureteral reimplantation in infants and children:effect on bladder function[J].J Urol,2002,167(1):285-287.DOI:10.1097/00005392-200201000-00084.
[18] 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(47):47.e1-47.e7.DOI:10.1016/j.jpurol.2016.09.009.
[19] Gander R,Asensio M,Royo GF,et al.Laparoscopic extravesical ureteral reimplantation for correction of primary and secondary megaureters:preliminary report of a new simplified technique[J].J Pediatr Surg,2020,55(3):564-569.DOI:10.1016/j.jpedsurg.2019.05.028.
[20] Lopez M,Gander R,Royo G,et al.Laparoscopic-assisted extravesical ureteral reimplantation and extracorporeal ureteral tapering repair for primary obstructive megaureter in children[J].J Laparoendosc Adv Surg Tech A,2017,27(8):851-857.DOI:10.1089/lap.2016.0456.
[21] Lopez M,Perez-Etchepare E,Bustangi N,et al.Laparoscopic extravesical reimplantation in children with primary obstructive megaureter[J].J Laparoendosc Adv Surg Tech A,2023,33(7):713-718.DOI:10.1089/lap.2019.0396.
[22] Shrestha AL,Bal HS,Kisku SMC,et al.Outcome of end cutaneous ureterostomy (ECU) as a non conservative option in the management of primary obstructive megaureters (POM)[J].J Pediatr Urol,2018,14(6):541.e1-541.e5.DOI:10.1016/j.jpurol.2018.05.004.
[23] Kitchens DM,DeFoor W,Minevich E,et al.End cutaneous ureterostomy for the management of severe hydronephrosis[J].J Urol,2007,177(4):1501-1504.DOI:10.1016/j.juro.2006.11.076.
[24] Lee SD,Akbal C,Kaefer M.Refluxing ureteral reimplant as temporary treatment of obstructive megaureter in neonate and infant[J].J Urol,2005,173(4):1357-1360.DOI:10.1097/01.ju.0000152317.72166.df.
[25] Alyami FA,Koyle MA,Bowlin PR,et al.Side-to-side refluxing nondismembered ureterocystotomy:a novel strategy to address obstructed megaureters in children[J].J Urol,2017,198(5):1159-1167.DOI:10.1016/j.juro.2017.05.078.
[26] Kaefer M,Misseri R,Frank E,et al.Refluxing ureteral reimplantation:a logical method for managing neonatal UVJ obstruction[J].J Pediatr Urol,2014,10(5):824-830.DOI:10.1016/j.jpurol.2014.01.027.
Memo
收稿日期:2024-6-7。
基金项目:国家自然科学基金(82000643);江苏省卫生健康委科研项目(M2021007)
通讯作者:郭云飞,Email:guozhaooso@163.com