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

Abstract

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.

Keywords

• 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

Abstract

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

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