小児尿管瘤に対する経尿道的瘤切開術の検討

Abstract

過去9年間に10例の小児尿管瘤症例を経験し, これらに対して第一選択として経尿道的瘤切開術を施行した.術後vesicoureteral refluxを認めたものの, 殆どの症例で術後水腎症は改善され, 所属腎機能は保存された.術式を更に検討すれば, 所属腎を温存しうる点で, 経尿道的瘤切開術は第一選択されるべき術式であると考えられた

Transurethral incision (TUI) was performed as the initial treatment in 10 children with ureteroceles. Three patients had ureteroceles associated with a single ureter. TUI relieved hydronephrosis and preserved renal function in all 3 cases. Urinary tract infection developed in no patients. However, all the patients required an antireflux operation because of postoperative vesicoureteral reflux (VUR). Seven children had a total of 8 ureteroceles associated with a duplex system. TUI resulted in preservation of the upper pole function in 6 of the 8 ureteroceles. Urinary tract infections and VUR developed in 3 and 7 patients, respectively. Common sheath reimplantation was performed in 2 ureteroceles. TUI relieves obstruction before the onset of devastating infections although it carries the risk of postoperative VUR. We recommend TUI as the initial treatment for ureteroceles associated with both single and duplex systems.