ABSTRACT
OBJECTIVES: Classically, the diagnosis of ectopic ureter was done in grown up girls due to urinary incontinence, today the diagnoses are more precocious, which has partially changed treatment. The objective of this paper is to perform a review of our experience over the last years and to correlate it with the current type of presentation. METHODS: We studied all patients with the diagnosis of ectopic ureter in a period of 10 years, between 1997 and December 2006. Demographic characteristics, type of presentation, diagnostic tests performed, age at the time of diagnosis and treatment were all analyzed, altogether with the different techniques employed for treatment. RESULTS: We found 19 patients with this disease, 15 of them females. Type of presentation was febrile urinary tract infection in 13 patients, urinary incontinence in two, and prenatal diagnosis of hydronephrosis in 4. Sixteen children had double pyeloureteral systems and only three had single systems. In all cases the diagnosis was performed with renal-bladder ultrasound, urethrocystogram and endoscopic studies. Additional studies such as excretion pyelograms were performed in 8 patients at the start of the series and nuclear medicine tests in 17. Median age at the time of diagnosis was eight months. All patients underwent surgical treatment. In patients with double systems superior heminephroureterectomy was performed in 8 patients, vesicoureteral reimplantation in three and pyelopyelic anastomosis in three cases with upper pole remnant function. In another two cases nephroureterectomy was performed due to the presence of reflux to the lower or system and severe renal compromise. In all three cases with single systems ureter reimplantation was performed. CONCLUSIONS: Currently prenatal suspicion and adequate study of urinary tract infections enable confirmation of ectopic ureter. Few children debut with urinary incontinence currently, due to the precocity of diagnosis. Treatment is always surgical, and basically depends on renal function, and the presence or absence of vesicoureteral reflux. Vesicoureteral reimplantation is performed preferentially in patients with ectopic ureter and a single system, and superior heminephrectomy in those with double systems, leaving the distal ureter of first option.
Subject(s)
Ureter/abnormalities , Congenital Abnormalities/diagnosis , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
OBJECTIVES: The VUR is one of the most frequent pathologies in pediatric urology. Classically it has been managed with medical or surgical treatment depending on age, grade, and other variables. Over the last years, urologists have started to perform endoscopic treatment with various substances, surgery but minimally invasive. The objective of this work is to evaluate our results with this method. METHODS: Between 1996 and 2004 we performed endoscopic treatment on 41 patients (70 ureters) using different substances. We analyze VUR grade and side, improvement with one or more injections, post-operative follow-up with clinical evaluation, bladder ultrasound and voiding cystourethrogram (VCUG), and compare the long-term results of the different substances used, mainly with the evaluation of recurrences and/or urinary tract infections. RESULTS: 41 patients entered the study; collagen was injected in 13 cases, Macroplastique in 14, and Deflux in 14. Twenty-nine patients underwent bilateral injection, adding up to a total of 70 injected ureters. Collagen injection had a success rate of 53% with the first injection and 77% with the second, Macroplastique success rate was 83% with the first injection and 91% with the second, and Deflux 84% on first injection and 88% with the second. Mean post-operative follow-up was 44 months, with a range of 18-86 months. 18% of the patients presented post operative UTI, they were treatment failures. There are no UTI episodes in patients after successful treatment. CONCLUSIONS: Endoscopic treatment is a useful tool in the long-term management of VUR, both as definitive treatment or as on alternative to conventional medical management, with better results when using Macroplastique and Deflux.
Subject(s)
Collagen , Dextrans , Dimethylpolysiloxanes , Hyaluronic Acid , Vesico-Ureteral Reflux/therapy , Adolescent , Child , Child, Preschool , Cystoscopy , Female , Humans , Infant , Male , Time Factors , UreteroscopyABSTRACT
Objetivo: El RVU es una de las patologías más frecuentes en la urología pediátrica, clásicamente se ha manejado con tratamiento médico o quirúrgico dependiendo de la edad, grado u otras variables. En los últimos años se ha comenzado a utilizar el tratamiento endoscópico, con distintas sustancias, el cual siendo quirúrgico es mínimamente invasivo. El objetivo de este trabajo es evaluar nuestros resultados con este método. Métodos: Entre 1996 y el 2004 se utilizó tratamiento endoscópico en 41 pacientes (70 uréteres) usando diferentes sustancias. Se analizó el grado y lateralidad del RVU, mejoría con 1 o más inyecciones, control post operatorio con clínica, ecografía renal vesical y uretrocistografía, y se compararon los resultados con las distintas sustancias usadas a largo plazo, evaluando principalmente las recidivas y/o cuadros de infección urinaria. Resultados: 41 pacientes entraron al estudio, se inyecto colágeno en 13, Macroplastique® en 14 y en 14 Deflux®. 29 pacientes recibieron inyección bilateral, resultando un total de 70 uréteres inyectados Con colágeno hubo 53% de éxito con la primera inyección y 77% con la segunda, con Macroplastique ® hubo 83% de éxito con la primera inyección y 91% con la segunda y con Deflux® 84% de éxito con la primera inyección Y 88% con la segunda inyección. El seguimiento post operatorio fue en promedio de 44 meses, con un rango de 18 a 86 meses. 18% presentó ITU post operatoria la que sé presento en pacientes con falla en el tratamiento. En el seguimiento no hay episodios de ITU en los pacientes con éxito en la aplicación de la sustancia. Conclusiones: El tratamiento endoscopio es una herramienta útil en el manejo del RVU a largo plazo, ya sea como tratamiento definitivo o como alternativa al manejo médico convencional, obteniendo mayor respuesta con Macroplastique® y Deflux® (AU)
Objectives: The VUR is one of the most frequent pathologies in pediatric urology. Classically it has been managed with medical or surgical treatment depending on age, grade, and other variables. Over the last years, urologists have started to perform endoscopic treatment with various substances, surgery but minimally invasive. The objective of this work is to evaluate our results with this method. Methods: Between 1996 and 2004 we performed endoscopic treatment on 41 patients (70 ureters) using different substances. We analyze VUR grade and side, improvement with one or more injections, post-operative follow-up with clinical evaluation, bladder ultrasound and voiding cystourethrogram (VCUG), and compare the long-term results of the different substances used, mainly with the evaluation of recurrences and/or urinary tract infections. Results: 41 patients entered the study; collagen was injected in 13 cases, Macroplastique® in 14, and Deflux® in 14. Twenty-nine patients underwent bilateral injection, adding up to a total of 70 injected ureters. Collagen injection had a success rate of 53% with the first injection and 77% with the second, Macroplastique® success rate was 83% with the first injection and 91% with the second, and Deflux® 84% on first injection and 88% with the second. Mean post-operative follow-up was 44 months, with a range of 18-86 months. 18% of the patients presented post operative UTI, they were treatment failures. There are no UTI episodes in patients after successful treatment. Conclusions: Endoscopic treatment is a useful tool in the long-term management of VUR, both as definitive treatment or as an alternative to conventional medical management, with better results when using Macroplastique® and Deflux® (AU)
