Diagnosis And Treatment Of Unilateral Dysplasia Of Kidney And Ureteral Ectopic

BackgroundRenal dysplasia with ureteroalveolar ectopic disorder is a relatively rare form of genitourinary system.Males often have recurrent urinary tract infections.Women often have persistent urinary leaks in addition to normal urinary activity.Renal dysplasia refers to the abnormal development of the kidney,resulting in abnormal size,shape,and structure.It is composed of nonfunctional tumor-like renal tissues,and loses the normal kidney morphology and function,and is often associated with an ectopic ureter.The etiology and pathogenesis are not yet completely clear,but when the small kidney with ureteral opening is ectopic,the renal pelvis often expands and the ureteral opening is small.The survey found that poor kidney development of domestic incidence rate of about 2.9 percent 100,000,such as merging the incidence of ectopic ureter will be lower.Patients with dysplasia kidney and ectopic ureter ectopic clinic are more common than females,2.6 times of that of males.Due to the small size,poor function and location of the kidneys,it is difficult to confirm the diagnosis through a single auxiliary examination,usually by color Doppler ultrasound,intravenous pyelography(IVP),CT urography(CTU),magnetic resonance urography.Contrast-enhanced(MRU),99mTc-DMSA radionuclide renal static imaging combined with retrograde catheterization as an important complementary method.Because this disease is a pediatric congenital disease,drugs and conservative treatment is invalid,surgery is the only method of treatment,in which if the contralateral renal function is normal,ipsilateral dysplasia of the kidney and ureteral resection,the traditional open surgery is relatively simple,far The success rate of surgery is high,but the length of the incision is about 5-10 cm.It has the disadvantages of large trauma,bleeding,and slow recovery.With the advancement of laparoscopic techniques and surgical equipment,many scholars believe that laparoscopic dysplasia of the kidney and ureterectomy has the advantages of less trauma,quicker recovery,and less complications,which can replace the traditional open surgery.At present,laparoscopic laparoscopy includes both intraperitoneal approach and retroperitoneal approach.Some scholars believe that the surgical approach via the abdominal route is large and the anatomical landmarks are easily identifiable.This approach is recommended;some scholars believe that The peritoneal approach has less invasiveness and less incision trauma,and this approach has less impact on abdominal organs.The authors generally believe that the prognosis after renal and ureteral resection is better and the symptoms disappear,but there is no detailed statistical analysis of the results of laparoscopic surgery and postoperative prognosis.In this study,we analyzed the data of 64 cases of children with unilateral dysplasia and ectopic ureteral malformation diagnosed in the Department of Pediatric Urology of the First Affiliated Hospital of Zhengzhou University,and combined the literature to discuss the diagnosis,treatment and prognosis of the disease.ObjectsThis study aims to analyze the etiology,pathogenesis,clinical manifestations,auxiliary examination,pathological features,diagnosis and differential diagnosis of unilateral renal dysplasia and ureteroventhexia,compare the results of laparoscopic surgery and prognosis.Clinicians refer to the diagnosis and treatment system.MethodsThe subjects included in this study were all diagnosed as unilateral renal dysplasia and ectopic ureteral ostia at the Department of Pediatric Urology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province,from January 1,2012 to December 31,2016,and Sixty-four children underwent surgery.In the treatment group,64 children with dysplastic kidney and ectopic ureteral opening were all female,and the average age is 4.4(three-six years).There were 38 cases on the left side and 26 cases on the right side.The clinical manifestations were mainly urinary droppings outside the normal micturition period,and the amount was small,and 13 cases had repeated urinary tract infections.Seven cases of physical examination showed a small amount of clear urine spillage in the perineal vestibule,and 55 cases of perineal eczema.Of the 64 cases in this group,only 9 cases underwent intravenous urinary tract urography(IVU).In this group of children,58 cases underwent CT urography(CTU),and MRU was performed by magnetic resonance urography.Of the 18 cases,54 cases had undergone radionuclide renal static imaging.All the patients had undergone 1 or 2 color Doppler ultrasound examinations on the special plane.Only 5 cases refused to perform a second color Doppler ultrasound examination.Therefore,dysplastic kidneys have not been explored.With the consent of the family members of the children,they were randomly divided into laparoscopic surgery group and laparoscopic surgery group.64 patients in this group were treated with tracheal intubation under general anesthesia: 35 cases underwent abdominal laparoscopy Underresection of dysplastic nephropathy and part of the ureters were used in the umbilical and both sides of the abdomen(specific location according to the position of the kidney before surgery to determine the position)three-hole method into the 5mm Trocar,intraoperative than the iliac vessels found near the ureter,and then separated upward until the removal Complete small kidney and most ureters.Twenty-nine cases of laparoscopic resection of dysplastic kidneys and ureters were performed laparoscopically.Intraoperative exploration of dysplastic nephrons was performed based on imaging data.From there,the distal ureter was dissociated and most of the ureters were removed.ResultsIn this group of 64 children,ectopic ureteral openings: 32 cases of vagina,17 cases of vestibular,7 cases of distal urethra,5 cases of bladder neck mouth,3 cases of unknown location.Ultrasound examination of 64 cases,57 cases of dysplastic kidneys,of which 31 cases of ectopic ureteral opening detection.Kidney static imaging examination of 54 cases of dysplastic nephrolithiasis in 51 cases,19 cases in the renal fossa were examined,19 cases were detected,and 24 cases of renal static nuclide imaging were examined in the palate.Example;The pelvic department performed the examination in 11 cases,and 10 cases were detected.No ectopic ureteral opening was detected.CTU examination found 55 cases of stunted kidneys in 58 cases,including 21 cases of kidneys with dysplasia in 21 cases;23 cases in 25 cases in the sacrum,and 11 cases in 12 cases in the pelvis,of which ectopic ureter was detected 45 example.In 18 patients with magnetic resonance urography(MRU)examination,18 cases of dysplastic nephropathy were detected during the examination,and 13 cases of ectopic ureteral orifice were detected.Nine cases of venous renal pelvis showed urethra angiography in 1 case.The stunting kidney was located in the kidney socket and no ureter imaging was observed.All of the above 27 patients underwent surgical treatment.There were still 2 cases of urinary incontinence after operation.Weixikang was significantly better than before.In the remaining 26 cases,the symptoms of leakage of urine disappeared on the day after operation,Color Doppler ultrasound and urine routine examinations were performed in January,March,June and one year after operation.Follow-up 6 to 24 months,there was no leakage of urine,abnormal urination,or ureteral stump syndrome,diseases and urinary tract infections.ConclusionsColor Doppler ultrasonography,CTU,MRU and renal static nuclide imaging all have good diagnostic value for hand diagnosis of dysplastic kidney with ectopic ureteral opening.If the stunted kidney is located in the kidney socket,the posterior abdominal pathway may be selected.However,in the pelvic region of the sacrum or more distal,or the patient whose kidney location is not clearly defined before surgery,it is suitable for the transperitoneal approach.