复制肾上极外异位输尿管的体外再植术

G. Makarov, V. Sizonov, V. Orlov, V. V. Vigera
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摘要

输尿管外异位是一种罕见的尿失禁的原因。我们报告一例3岁女童尿失禁。该女孩观察并治疗复发性尿路感染(UTI),背景是左侧上尿路重复和膀胱输尿管反流(VUR)。使用右旋氨基聚体/透明质酸进行两次内镜治疗,可以消除两侧的VUR,并实现临床和实验室尿路感染的稳定缓解。经过如厕训练后,孩子在正常排尿的同时也有持续的尿滴。检查发现左侧重复肾上极输尿管外异位,左侧膀胱三角区投影处膀胱占位性肿块伴高密度包涵体,我们认为这是移植物迁移和组织病理学改变的结果。膀胱占位性肿块的存在决定了手术技术的选择,有利于形成输尿管膀胱吻合与重复异位输尿管和膀胱占位性肿块的去除。在对内镜下VUR治疗后的患者进行管理时,应考虑由于钙和尿酸盐的积累而导致填充剂形态学改变的可能性。
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Extravesical reimplantation of an extravesical-ectopic ureter from the upper pole of a duplicated kidney
Extravesical ureter ectopia is a rare cause of urinary incontinence. We are reporting a case of a 3-year-old girl with urinary incontinence. The girl was observed and treated for recurrent urinary tract infection (UTI) against the background of left-side duplication of the upper urinary tract and vesicoureteral reflux (VUR). Two-time endoscopic treatment using a dextranomer/hyaluronic acid allowed to eliminate VUR on both sides and achieve stable clinical and laboratory remission of UTI. After potty training, the child had a constant drip of urine along with normal urination. The examination revealed extravesical ureter ectopia of the left duplicated kidney upper pole and a bladder space-occupying mass with hyperdensive inclusions in the projection of the vesical trigone on the left, which we regarded as a result of the migration of the implant and the appearance of histopathological changes in it. The presence of a bladder space-occupying mass determined the choice of the surgical technique in favor of the formation of a ureterocystoanastomosis with a duplicated ectopic ureter and the removal of a bladder space-occupying mass. When managing patients after endoscopic treatment of VUR, it should be considered the possibility of morphological changes in the bulking agent due to the accumulation of calcium and uric acid salts.
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