Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience

IF 0.9 4区 医学 Q4 UROLOGY & NEPHROLOGY Current Urology Pub Date : 2023-10-25 DOI:10.1097/cu9.0000000000000228
Leon Chertin, Binyamin B. Neeman, Jawdat Jaber, Guy Verhovsky, Amnon Zisman, Ariel Mamber, Ilan Kafka, Ala Eddin Natsheh, Dmitry Koulikov, Ofer Z. Shenfeld, Boris Chertin, Stanislav Koucherov, Amos Neheman
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Abstract

Abstract Purpose To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results The study included 102 patients with a median age of 25 (interquartile range, 23–36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12–54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1–2). Conclusions Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
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成人先天性泌尿系统疾病的处理经验:儿科泌尿科医生应该知道的和成人泌尿科医生在儿科实践中采用的经验
摘要目的总结成人先天性肾尿路异常(CAKUT)的治疗经验。材料和方法:我们对1998年至2021年间因ckut接受初级手术治疗的所有成年患者进行了回顾性图表回顾。结果纳入102例患者,中位年龄25岁(四分位数范围23-36.5)。其中85例(83.3%)患者的产前超声检查正常,其余17例(16.7%)患者诊断为产前肾积水。这些患者在出生后进行了保守随访,由于缺乏手术干预的指征或因为他们决定离开医疗护理而退出随访。所有被研究的成年患者均有以下病理表现:肾盂输尿管连接处梗阻67例,输尿管异位14例,输尿管囊肿9例,原发性梗阻性输尿管6例,其余6例诊断为膀胱输尿管反流。43%的患者有与异位输尿管或输尿管囊肿相关的功能不良的部分。值得注意的是,67%的患者接受了肾盂成形术,9%的患者接受了内窥镜输尿管囊肿穿刺,3%的患者接受了输尿管再植术,6%的患者接受了内窥镜纠正反流,7%的患者接受了部分无功能部分的肾切除术,其余9%的患者接受了机器人辅助的腹腔镜输尿管输尿管造口术。术后中位随访时间为33个月(四分位数间距12-54)。术后并发症5例(Clavien-Dindo 1-2)。结论CAKUT患者出现临床症状的时间较晚。在胎儿筛查期间确诊并接受保守治疗的患者的父母应该意识到这种可能性,儿童在进入青春期时应该得到适当的咨询。在儿科人群中使用的类似的外科技能和手术技术可能适用于成人。
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来源期刊
Current Urology
Current Urology Medicine-Urology
CiteScore
2.30
自引率
0.00%
发文量
96
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