Андрология и генитальная хирургия. 2024; 25: 139-146
Клинический случай полного удвоения правой почки в сочетании с нерефлюксирующим мегауретером верхнего и гидронефрозом нижнего сегментов
https://doi.org/10.62968/2070-9781-2024-25-1-139-146Аннотация
Удвоение почки в сочетании с обструктивными уропатиями верхнего и нижнего сегментов занимает особое место в детской урологии. Анатомия порока определяет целый ряд существенных функциональных и уродинамических нарушений, имеющих большое значение в жизни ребенка. Особенно это касается детей раннего возраста. У ребенка Г. антенатально на 20-й неделе гестации выявлено удвоение правой почки с мегауретером обеих половин без критического расширения ЧЛС и мочеточников. Лейкоцитурия (лейкоциты 500 в поле зрения), выявленная после рождения, явилась поводом для перевода ребенка в специализированное учреждение. В связи с течением тяжелого гнойного пиелонефрита на фоне обструкции мочеточников обеих половин в дистальном сегменте (расширение чашечно-лоханочной системы до 30 мм) установлены нефростомы. При проведении комплексного обследования в возрасте 3 месяцев установлен диагноз – гидронефроз нижней половины со снижением функции на 52%, нерефлюксирующий мегауретер верхней половины с отсутствием функции верхней половины правой удвоенной почки. Первым этапом проведена пластика прилоханочного отдела мочеточника нижней половины. В возрасте 6 месяцев – эпигеминефроуретерэктомия.
Удвоение почек в сочетании с обструктивными уропатиями требуют индивидуального наблюдения с антенатального периода и своевременного обследования после рождения.
Список литературы
1. Gearhart J, Rink R, Mouriquand P. Pediatric urology, 2nd ed., 2001 by Saunders, an imprint of Elsevier Inc.; 2010. 818 p.
2. Rasouly HM, Lu W: Lower urinary tract development and disease. Wiley Interdiscip Rev Syst Biol Med. 2013, 5:307-42. 10.1002/wsbm.1212
3. Abyaksa R, Pramod SV, Siregar S: Uterus as one of the ectopic ureter openings: case report . Urol Case Rep. 2021, 39:101830. 10.1016/j.eucr.2021.101830
4. Roy Choudhury S, Chadha R, Bagga D, Puri A, Debnath PR. Spectrum of ectopic ureters in children. Pediatr Surg Int. 2008;24:819–823.
5. Mathews R, Jeffs RD, Maizels M, Palmer LS, Docimo SG. Single system ureteral ectopia in boys associated with bladder outlet obstruction. J Urol. 1999;161:1297–1300.
6. Gangopadhyaya A.N., Uoadhayaya V.D., Panday A., Gupta D.K., Gopal S.C., Sharma S.P. Single system ectopic ureter in females: a single centre study. J Indian Assoc Pediatr Surg. 2007;4:202–205.
7. Duicu C, Kiss E, Simu I, Aldea C. A rare case of double-system with ectopic ureteral openings into vagina. Front Pediatr. 2018;6:176.
8. Mikuz G. Der Pathologe. Ectopias of the kidney, urinary tract organs, and male genitalia. 2019;40:1–8.
9. Wang DS, Bird VG, Cooper CS, Austin JC, Winfield HN. Laparoscopic upper-pole heminephrectomy for ectopic ureter: surgical technique. J Endourol. 2003 Sep;17(7):469-73. doi: 10.1089/089277903769013603.
10. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The society for fetal urology consensusstatement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. (2010) 6(3):212–31. doi: 10.1016/j.jpurol.2010.02.205
11. Wong NC, Braga LH. Open ureteroureterostomy for repair of upper-pole ectopic ureters in children with duplex systems: is stenting really necessary. J Pediatr Urol. (2019) 15(1):72.e1–7. doi: 10.1016/j.jpurol.2018.10.014
12. Sheth KR, White JT, Janzen N, Koh CJ, Austin PF, Roth DR, et al. Evaluating outcomes of differential surgical management of nonfunctioning upper pole renal moieties in duplex collecting systems. Urology. (2019) 123:198–203. doi: 10.1016/j.urology.2018.06.028
13. Polok M., Dzielendziak A. Laparoscopic Heminephrectomy for Duplex Kidney in Children—The Learning Curve Front. Pediatr., 02 April 2019. Sec. Pediatric Urology. Volume 7 - 2019 | https://doi.org/10.3389/fped.2019.00117
14. 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) 10:1089–94. doi: 10.1016/j.jpurol.2014.04.008
15. Biles MJ, Finkelstein JB, Silva MV, Lambert SM, Casale P. Innovation in robotics and pediatric urology: robotic ureteroureterostomy for duplex systems with ureteral ectopia. J Endourol. (2016) 30:1041–8. doi: 10.1089/end.2015.0645
16. Wu C., Ji F., Zhang F. Treatment for complete bilateral duplex kidneys with severe hydronephrosis and ureterectasis of the upper moiety in a child: A case report and literature review. Front. Surg., 02 November 2022. Sec. Pediatric Surgery. Volume 9 - 2022 | https://doi.org/10.3389/fsurg.2022.1019161.
17. К Athiya Perveen, Mathews Shirbin Joe, Varghese Thomas P. Clinical profile of duplex kidneys in children and its association with vesicoureteric reflux. Egyptian Pediatric Association Gazette 71(1) DOI:10.1186/s43054-023-00165-y.
Andrology and Genital Surgery. 2024; 25: 139-146
Clinical case of complete duplication of the right kidney in combination with non-refluxing megaureter of the upper and hydronephrosis of the lower segments
https://doi.org/10.62968/2070-9781-2024-25-1-139-146Abstract
The duplex kidney assosiated with obstructive uropathy of the upper and lower segments is a condition difficult to manage in pediatric urology. Embryological predisposition determines a number of significant functional and urodynamic disorders that are common in children at the age of 3 years. That decrease the quality of children’s lives, especially under 3 years old. The article presents a clinical case of a 3-month girl. The 20-week antenatal ultrasound scan showed a duplication of the right kidney with megaureter of both segments without critical dilation. The leukocyturia was detected after birth. The child was admitted to the surgical hospital. Nephrostomy tubes were inserted in the duplex kidney due to severe purulent pyelonephritis. The girl was diagnosed with hydronephrosis of the lower segment with a decreased function by 52%, non-refluxing megaureter of the upper segment with absence of upper half kidney function. Pyeloplastic of the lower half of the ureter was performed. Epigeminefroureterectomy of the upper half of the kidney was performed at 6 months.
In conclusion, duplex kidney assosiated with obstructive uropathy requires timely diagnosis and patient follow-up.
References
1. Gearhart J, Rink R, Mouriquand P. Pediatric urology, 2nd ed., 2001 by Saunders, an imprint of Elsevier Inc.; 2010. 818 p.
2. Rasouly HM, Lu W: Lower urinary tract development and disease. Wiley Interdiscip Rev Syst Biol Med. 2013, 5:307-42. 10.1002/wsbm.1212
3. Abyaksa R, Pramod SV, Siregar S: Uterus as one of the ectopic ureter openings: case report . Urol Case Rep. 2021, 39:101830. 10.1016/j.eucr.2021.101830
4. Roy Choudhury S, Chadha R, Bagga D, Puri A, Debnath PR. Spectrum of ectopic ureters in children. Pediatr Surg Int. 2008;24:819–823.
5. Mathews R, Jeffs RD, Maizels M, Palmer LS, Docimo SG. Single system ureteral ectopia in boys associated with bladder outlet obstruction. J Urol. 1999;161:1297–1300.
6. Gangopadhyaya A.N., Uoadhayaya V.D., Panday A., Gupta D.K., Gopal S.C., Sharma S.P. Single system ectopic ureter in females: a single centre study. J Indian Assoc Pediatr Surg. 2007;4:202–205.
7. Duicu C, Kiss E, Simu I, Aldea C. A rare case of double-system with ectopic ureteral openings into vagina. Front Pediatr. 2018;6:176.
8. Mikuz G. Der Pathologe. Ectopias of the kidney, urinary tract organs, and male genitalia. 2019;40:1–8.
9. Wang DS, Bird VG, Cooper CS, Austin JC, Winfield HN. Laparoscopic upper-pole heminephrectomy for ectopic ureter: surgical technique. J Endourol. 2003 Sep;17(7):469-73. doi: 10.1089/089277903769013603.
10. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The society for fetal urology consensusstatement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. (2010) 6(3):212–31. doi: 10.1016/j.jpurol.2010.02.205
11. Wong NC, Braga LH. Open ureteroureterostomy for repair of upper-pole ectopic ureters in children with duplex systems: is stenting really necessary. J Pediatr Urol. (2019) 15(1):72.e1–7. doi: 10.1016/j.jpurol.2018.10.014
12. Sheth KR, White JT, Janzen N, Koh CJ, Austin PF, Roth DR, et al. Evaluating outcomes of differential surgical management of nonfunctioning upper pole renal moieties in duplex collecting systems. Urology. (2019) 123:198–203. doi: 10.1016/j.urology.2018.06.028
13. Polok M., Dzielendziak A. Laparoscopic Heminephrectomy for Duplex Kidney in Children—The Learning Curve Front. Pediatr., 02 April 2019. Sec. Pediatric Urology. Volume 7 - 2019 | https://doi.org/10.3389/fped.2019.00117
14. 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) 10:1089–94. doi: 10.1016/j.jpurol.2014.04.008
15. Biles MJ, Finkelstein JB, Silva MV, Lambert SM, Casale P. Innovation in robotics and pediatric urology: robotic ureteroureterostomy for duplex systems with ureteral ectopia. J Endourol. (2016) 30:1041–8. doi: 10.1089/end.2015.0645
16. Wu C., Ji F., Zhang F. Treatment for complete bilateral duplex kidneys with severe hydronephrosis and ureterectasis of the upper moiety in a child: A case report and literature review. Front. Surg., 02 November 2022. Sec. Pediatric Surgery. Volume 9 - 2022 | https://doi.org/10.3389/fsurg.2022.1019161.
17. K Athiya Perveen, Mathews Shirbin Joe, Varghese Thomas P. Clinical profile of duplex kidneys in children and its association with vesicoureteric reflux. Egyptian Pediatric Association Gazette 71(1) DOI:10.1186/s43054-023-00165-y.
