Transurethral Fenestration with Holmium Laser for Duplex Kidney Combined with Ureterocele in Children
10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2021.0412
- VernacularTitle:经尿道钬激光开窗治疗儿童重复肾合并输尿管囊肿
- Author:
Yin ZHANG
1
;
Min CHAO
2
;
Jian SHEN
3
;
Jia-bin JIANG
2
;
Ye ZHANG
2
;
Xiang FANG
2
;
Kai-ping ZHANG
2
;
Xian-sheng ZHANG
1
Author Information
1. Department of Urology， The First Affiliated Hospital of Anhui Medical University， Hefei， 230022， China
2. Department of Urology， Anhui Provincial Children’s Hospital / Children’s Hospital of Fudan University Affiliated Anhui Branch， Hefei， 230051， China
3. Department of Urology， Children’s Hospital of Fudan University， Shanghai， 201102， China
- Publication Type:Journal Article
- Keywords:
YAG laser;
ureterocele;
duplex kidney and ureter;
minimal invasive;
fenestration;
children
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2021;42(4):563-570
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the efficacy of transurethral fenestration with holmium laser as the initial management for duplex kidney associated with ureterocele in children. MethodsThe clinical data of 35 children with duplex kidney and ureterocele who underwent surgical treatment in our department from January 2016 to December 2020 were retrospectively analyzed. According to the different initial treatment options， the subjects were divided into two groups： transurethral fenestration by holmium： YAG laser （group A） and single-port laparoscopic heminephrectomy and transperitoneal single-port laparoscopic ureterovesical replantation（group B）. Group A （n=22） received endoscopic holmium laser ureterotomy and group B （n=13） underwent kidney or bladder level reconstruction and ureterocele exclusion surgery. The age， gender， upper urinary tract condition， location of ureterocele， preoperative and postoperative vesicoureteral reflux， postoperative complications requiring additional surgery were recorded and statistically analyzed. ResultsIn group A， 13 cases had cyst crumpled and hydronephrosis subsided， 4 cases had completely disappeared cysts， de novo vesicoureteral reflux occurred in 8 cases， 5 cases underwent reoperation 3~6 months after operation， among which 4 cases underwent ureterovesical replantation because of urinary tract infection by de novo vesicoureteral reflux， 1 case received heminephrectomy and cystoscopic cystectomy because of the cyst collapse. In group B， 9 cases had favorable prognosis， 4 cases underwent reoperation from 6 to 12 months after operation， among which 1 case underwent replantation due to postoperative anastomotic obstruction， 3 cases underwent replantation due to ureteral stump syndrome. The mean operation time between group A and B was （31.77±13.43） min vs. （174.46±37.79） min，t=-13.131，P=0.000； the mean hospital stay was （2.27±1.93） d vs. （11.54±7.33） d，t=-4.465，P=0.001， and the difference was statistically significant. There was no significant difference in the early reoperation rate between the two groups （Fisher P=0.698）. ConclusionEndoscopic fenestration with holmium laser could be used as the initial management for duplex kidney combined with ureterocele in infants and young children.
