Antenatal Hidroüreteronefroz ile Başvuran 3 Günlük Erkek Olgu
Özet
Bu vaka sunumunda, prenatal takiplerinde sol hidronefrozu saptanan ve doğum sonrası üçüncü günde yapılan ultrasonografide sol üreterde ileri düzeyde genişleme, yer yer incelmiş böbrek parankimi ve mesane içerisinde üreterosel ile uyumlu görünüm saptanan üç günlük bir erkek yenidoğan olgusu ele alınmaktadır. Üreterosel, distal üreterin kistik genişlemesiyle oluşan bir ektopik üreter biçimi olup, çoğunlukla çift toplayıcı sistemlerin üst polü ile ilişkilidir ve kız çocuklarında erkeklere göre çok daha sık görülür. Hastanın tedavisinde öncelikle antibiyotik profilaksisi başlanmış ve ağır obstrüksiyon nedeniyle bugbee elektrokoter yardımıyla endoskopik dekompresyon uygulanmıştır. Postoperatif takiplerde sol üriner sistemdeki dilatasyonun gerilediği ve parankim kalınlığının arttığı gözlenmiştir. İki aylıkken çekilen DMSA sintigrafisinde üst polün afonksiyone olduğu görülmüştür. Günümüzde afonksiyone üst pol varlığında heminefrektomi yerine cerrahi dışı veya daha minimal invaziv yaklaşımların da benzer sonuçlar sunduğu belirtilmektedir. Yeterli böbrek fonksiyonu bulunan olgularda ise endoskopik insizyon oldukça etkili ve başarılı bir başlangıç tedavisidir. Nadir de olsa üreterosellerle ilişkili olarak mesane disfonksiyonu ve stres inkontinansı gelişebilmekte, bu durumlar genellikle davranışsal değişiklikler ve medikal tedavilerle kontrol altına alınabilmektedir.
This case report presents a three-day-old male newborn who was found to have left hydronephrosis during prenatal follow-ups, and whose postnatal third-day ultrasonography revealed severe dilatation in the left ureter, partially thinned renal parenchyma, and a finding consistent with a ureterocele in the bladder. A ureterocele is a form of ectopic ureter resulting from the cystic dilatation of the distal ureter, mostly associated with the upper pole of duplex collecting systems, and is seen much more frequently in girls than in boys. In the management of the patient, antibiotic prophylaxis was initiated first, and endoscopic decompression was performed using a bugbee electrocautery due to severe obstruction. Postoperative follow-ups showed that the dilatation in the left urinary system regressed and the parenchymal thickness increased. A DMSA scintigraphy performed at two months of age showed that the upper pole was non-functioning. Today, it is noted that in the presence of a non-functioning upper pole, non-surgical or more minimally invasive approaches yield similar results instead of heminephrectomy. In patients with adequate renal function, endoscopic incision is a highly effective and successful initial treatment. Although rare, bladder dysfunction and stress incontinence associated with ureteroceles may develop, and these conditions can generally be controlled with behavioral modifications and medical treatment.
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