Antenatal Hidronefroz Sebebi ile Başvuran 2 Günlük Kız Olgu
Özet
Bu makale, antenatal hidronefroz nedeniyle takip edilen ve iki günlükken sağ böbrek üst polünde kist ön tanısı alan bir kız olgunun klinik sürecini incelemektedir. İki aylıkken yapılan ultrasonografide, sağ tarafta 2,5 cm boyutunda üreterosel ile sonlanan, ciddi hidroüreteronefrotik ve displastik üst pole sahip çift toplayıcı sistem saptanmıştır. Yapılan sintigrafide sağ üst polün çalışmadığı, işeme sistoüretrografisinde (İSUG) ise vezikoüreteral reflü (VUR) saptanmadığı görülmüştür. Tedavi reddi ve profilaksi kesilmesi sonrasında 13 aylıkken üreterosel prolapsusuna bağlı akut idrar retansiyonu ile acile başvuran olguya acil cerrahi insizyon yapılmış ve rahat işemesi sağlanmıştır. Postoperatif 3. ayda çekilen kontrol İSUG teknik açıdan yetersiz bulunmuş olup klinikte yol gösterici olamamıştır. Bu aşamada literatürde tam onarım (üst ve üreterosel eksizyonu ile üreteroneosistostomi), sadece üst pol heminefrektomisi, sadece üreterosel eksizyonu ile ortak kılıf korunarak üreteroneosistostomi yapılması veya tuvalet eğitimine kadar antibiyotik profilaksisi altında konservatif izlem gibi farklı tedavi yaklaşımları tartışılmaktadır.
This article examines the clinical course of a female infant followed for antenatal hydronephrosis, who was prediagnosed with a cyst in the upper pole of the right kidney at two days of age. An ultrasonography performed at two months revealed a right duplex collecting system with a severely hydroureteronephrotic and dysplastic upper pole ending in a 2.5 cm ureterocele. Scintigraphy showed almost no function in the right upper pole, while voiding cystourethrography (VCUG) revealed no vesicoureteral reflux (VUR). Following treatment rejection and cessation of prophylaxis by the family, the patient presented to the emergency department at 13 months with acute urinary retention due to ureterocele prolapse, and emergency surgical incision was performed, restoring normal voiding. A control VCUG performed at the postoperative third month was found technically inadequate and clinically unhelpful. At this stage, various treatment approaches are discussed in the literature, including complete reconstruction (excision of the upper pole and ureterocele with ureteroneocystostomy), upper pole heminephrectomy alone, ureterocele excision with ureteroneocystostomy preserving the common sheath, or conservative follow-up under antibiotic prophylaxis until toilet training is completed.
Referanslar
Radmayr C, Bogaert G, Dogan HS, et al. EAU Guidelines on Paediatric Urology.; 2021. http://uroweb.org/guidelines/compilations-of-all-guidelines/
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):1526-1538. doi:10.1007/s00247-017-3904-z
Merguerian PA, Taenzer A, Knoerlein K, McQuiston L, Herz D. Variation in management of duplex system intravesical ureteroceles: A survey of pediatric urologists. J Urol. 2010;184(4 SUPPL.):1625-1630. doi:10.1016/j.juro.2010.03.113
Coplen DE, Austin PF, Strand B, Brock J, Mitchell M. Outcome analysis of prenatally detected ureteroceles associated with multicystic dysplasia. J Urol. 2004;172(4 II):1637-1639. doi:10.1097/01.ju.0000138380.77747.7d
Direnna T, Leonard MP. Watchful waiting for prenatally detected ureteroceles. J Urol. 2006;175(4):1493-1495. doi:10.1016/S0022-5347(05)00676-2
Han MY, Gibbons MD, Belman AB, et al. Indications for nonoperative management of ureteroceles. J Urol. 2005;174(4 II):1652-1656. doi:10.1097/01.ju.0000175943.95989.41
Andrioli V, Guerra L, Keays M, et al. Active surveillance for antenatally detected ureteroceles: Predictors of success. J Pediatr Urol. 2018;14(3):243.e1-243.e6. doi:10.1016/j.jpurol.2018.02.012
Castagnetti M, Cimador M, Esposito C, Rigamonti W. Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele. Nat Rev Urol. 2012;9(6):321-329. doi:10.1038/nrurol.2012.89
Ben Meir D, Silva CJTDAE, Rao P, Chiang D, Dewan PA. Does the endoscopic technique of ureterocele incision matter? J Urol. 2004;172(2):684-686. doi:10.1097/01.ju.0000129228.92805.31
Chertin B, De Caluwé D, Puri P. Is primary endoscopic puncture of ureterocele a long-term effective procedure? J Pediatr Surg. 2003;38(1):116-119. doi:10.1053/jpsu.2003.50023
Jesus LE, Farhat WA, Amarante ACM, et al. Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles. J Urol. 2011;186(4):14551459. doi:10.1016/j.juro.2011.05.057
Mariyappa B, Barker A, Samnakay N, Khosa J. Management of duplex-system ureterocele. 2014;50:96-99. doi:10.1111/jpc.12474
Castagnetti M, Vidal E, Burei M, Zucchetta P, Murer L, Rigamonti W. Duplex system ureterocele in infants : Should we reconsider the indications for secondary surgery after endoscopic puncture or partial nephrectomy ? J Pediatr Urol. 2013;9(1):11-16. doi:10.1016/j.jpurol.2012.06.016
Keene DJB, Subramaniam R. Duplex systems : Top-down or bottom-up approach ? J Pediatr Urol. 2020;16(3):387.e1-387.e8. doi:10.1016/j.jpurol.2020.03.005
