Çocuklarda çift toplayıcı sistemlerde girişimsel yaklaşımlar: Klinik deneyimlerimiz ve literatürün gözden geçirilmesi

Amaç: Çift toplayıcı sistem (ÇTS) çocukluk çağında sık görülen ürüner sistem anomalileridir ve farklı anatomik varyasyonlardan oluşabilir. Tanı ve tedavisi henüz standartize edilmemiştir. Bu çalışmada amacımız, kliniğimizde ÇTS’li olgularımıza uygulanan girişimsel işlemleri literatür eşliğinde sunmaktır.Materyal ve Metod: Ocak 2011- Ağustos 2018 tarihleri arasında ÇTS’ye bağlı bulgu ve belirti veren olgular geriye dönük olarak değerlendirildi. Olguların demografik özellikleri, tanı yöntemleri, uygulanan girişimsel işlemler kaydedildi.Bulgular: Ortalama yaşları 5 yıl olan toplam 13 hastada en sık bulgu, idrar yolu enfeksiyonu idi. Tanı USG’de şüphelenilen olguların miksiyon sistoüretrografi, intravenöz ürografi ve manyetik rezonans ürografi çalışmaları ile konuldu. İki olguya üst kutup parsiyel nefrektomi, 4’üne üreterosel delinmesi, 4’üne vezikoüretrel reflü nedeni ile subüreterik enjeksiyon yapıldı. İki hastaya sadece sistoskopi yapıldı, bir olguya ise üreterolitotomi yapıldı. Üreterosel delinmesi yapılan 2 ve enjeksiyon yapılan 2 hastaya daha sonra ikincil işlem olarak üreteroneosistostomi yapıldı. Bir olgu hariç fonksiyon kaybı görülmedi.Sonuç: ÇTS’ye yaklaşımda agresif yöntemlerin yanında endoskopik az invaziv girişimlşer giderek daha sık uygulanmaktadır. Seçilecek girişimsel işlem, anomalinin tipine göre ve hastaya özgüdür.

Anahtar Kelimeler:

Çift toplayıcı sistem, üreterosel, vezikoüreteral reflü, Parsiyel nefrektomi

Interventional approaches in duplicated renal collecting systems in children: our clinical experiences and review of the literature

Background: Duplex collecting system (DCS) is a common anomaly in childhood and may be consist of different anatomical variations. Diagnosis and treatment has not yet been standardized. In this study, our aim is to present the interventional procedures applied to our patients with DCS in the light of the literature.Material and Methods: Patients with signs and symptoms related to DCS between January 2011 and August 2018 were evaluated retrospectively. Demographic characteristics, diagnostic methods and interventional procedures were recorded.Results: The most common finding was urinary tract infection in 13 patients (mean age is 5 years). Diagnosis was made by the cystourethrography, intravenous urography and magnetic resonance urography studies in cases with suspected US. Upper-pole partial nephrectomy was performed in two patients, ureterocele puncture in 4, subureteric injection for vesicouretric reflux in 4. Only cystoscopy was done in two patients, and ureterolithotony required in one. Ureteroneocystostomy was performed in 4 patients, two of whom had previously undergone ureterocele puncture and two of which had previously been subureteric injection. There was no loss of function except one case.Conclusions: In addition to aggressive methods, endoscopic minimally invasive procedures are increasingly used in the management of DCS. The interventional procedure is selected according to the type of the anomaly and specific to the patient.

Keywords:

Dublex collecting system, Ureterocele, Vesicoureteral reflux, Partial nephrectomy,

PDF

___

Glassberg KI, Braren V, Duckett JW, Jacobs EC, King LR, Lebowitz RL, et al. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol. 1984;132(6):1153-4.
Liu W, Zhang L, Ma R, Wu R. The morphology and treatment of coexisting ureteropelvic junction obstruction in lower moiety of duplex kidney. Int J Surg. 2016;34:23-7.
Corbett ST, Burris MB, Herndon CD. Pediatric robotic-assisted laparoscopic ipsilateral ureteroureterostomy in a duplicated collecting system. J Pediatr Urol. 2013;9(6 Pt B):1239.e1-2.
Didier RA, Chow JS, Kwatra NS, Retik AB, Lebowitz RL. The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 2017;47(11):1526-38.
Adeb M, Darge K, Dillman JR, Carr M, Epelman M. Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson ImagingClin N Am. 2013;21(4):717-30.
Castagnetti M, Vidal E, Burei M, Zucchetta P, Murer L, Rigamonti W. Duplex system ureterocele in infants: should were consider the indications for secondary surgery after endoscopic puncture or partial nephrectomy? J Pediatr Urol. 2013;9(1):11-6.
Sheth KR, White JT, Janzen N, Koh CJ, Austin PF, Roth DR, et al. Evaluating outcomes of differential surgical management of non-functioning upper pole renal moieties in duplex collecting systems. Urology. 2018; 19. pii: S0090-4295(18)30618-6.
Mariyappa B, Barker A, Samnakay N, Khosa J. Management of duplex-system ureterocele. J Paediatr Child Health. 2014;50(2):96-9.
Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr. 2013;50(2):215-31.
Ramanathan S, Kumar D, Khanna M, Al Heidous M, Sheikh A, Virmani V, et al. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract. World J Radiol. 2016;8(2):132-41.
Adiego B, Martinez-Ten P, Perez-Pedregosa J, Illescas T, Barron E, Wong AE, et al. Antenatally diagnosed renal duplex anomalies: sonographic features and long-term postnatal outcome. J Ultrasound Med. 2011;30(6):809-15.
Mendichovszky I, Solar BT, Smeulders N, Easty M, Biassoni L. Nuclear medicine in pediatric nephro-urology: An overview. Semin Nucl Med. 2017;47(3):204-28.
McLeod DJ, Alpert SA, Ural Z, Jayanthi VR. Ureteroureterostomy irrespective of ureteral size or upper pole function: a single center experience. J Pediatr Urol. 2014;10(4):616-9.
Romao RL, Figueroa V, Salle JL, Koyle MA, Bägli DJ, Lorenzo AJ. Laparoscopic ureteral ligation (clipping): a novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties. J Pediatr Urol. 2014;10(6):1089-94.
Husmann DA. Renal dysplasia: the risks and consequences of leaving dysplastic tissue in situ. Urology. 1998;52(4):533-6.
Chowdhary SK, Kandpal DK, Sibal A, Srivastava RN, Vasudev AS. Ureterocele in newborns, infants and children: Ten year prospective study with primary endoscopic deroofing and double J (DJ) stenting. J Pediatr Surg. 2017;52(4):569-73.
Shekarriz B, Upadhyay J, Fleming P, González R, Barthold JS. Long-term outcome based on the initial surgical approach to ureterocele. J Urol. 1999;162(3 Pt 2):1072-6.
Jayanthi VR, Koff SA. Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems. J Urol. 1999;162(3 Pt 2):1077-80.
Pohl HG. Recent advances in the management of ureteroceles in infants and children: why less may be more. Curr Opin Urol. 2011;21(4):322-7.
Hensle TW, Reiley EA, Ritch C, Murphy A. The clinical utility and safety of the endoscopic treatment of vesicoureteral reflux in patients with duplex ureters. J Pediatr Urol. 2010;6(1):15-22.
Thomas JC. Vesicoureteral reflux and duplex systems. Adv Urol. 2008:651891.