Cíl: Laparoskopická uretero-pyeloanastomóza (UPA) představuje alternativu v léčbě zdvojených anomálií ledvin se zachovanou funkcí horní moiety nebo tam, kde je heminefrektomie obtížná či riskantní. Cílem je zhodnotit naše dlouhodobé zkušenosti s touto technikou. Soubor: Retrospektivní hodnocení souboru 35 pacientů, u kterých byla v letech 2011–2023 provedena laparoskopická UPA. Ve třech případech šlo o inkompletní zdvojení ledviny s hydronefrózou dolního segmentu, v ostatních případech (32) o kompletní zdvojení s megaureterem horního segmentu zakončeným ureterokélou v devíti a ektopií močovodu ve 23 případech. Laparoskopickou operaci jsme indikovali u dětí starších jednoho roku, s minimální hmotností 10 kg, s významnou dilatací zdvojeného systému horních močových cest, bez vezikoureterálního refluxu do dolního a zachovalou funkcí horního segmentu. Hodnotili jsme věk pacientů v době operace, délku výkonu, úspěšnost, délku sledování a komplikace. Výsledky: Střední věk pacientů byl 29 (14–184) měsíců, střední délka výkonu 210 (110–320) minut. U všech pacientů došlo k významnému zmenšení či vymizení dilatace horních močových cest. Střední délka sledování byla 18 (5–120) měsíců, žádný z pacientů nevyžadoval reoperaci. Nejčastější komplikací byl časný únik moči z anastomózy u sedmi (20 %) dětí. Příčinou byla v pěti případech porucha drenáže (2× malfunkce nefrostomie, 3× malfunkce ureterální cévky), ve dvou případech pacient operovaný bez použití derivace. Komplikaci jsme vyřešili zavedením ureterálního katétru (3×) a ureterálního stentu (4×). Závěr: Laparoskopická UPA představuje alter- nativní způsob řešení některých forem zdvojených anomálií ledvin u dětí. Má vysokou úspěšnost a nízký výskyt komplikací. Nejčastější komplikací je únik moči z anastomózy, proto je nezbytné zvolit spolehlivý typ derivace moči.
Aim: Laparoscopic ureteropyelostomy (UPS) represents alternative method in treatment of duplex kidney anomalies with preserved function of upper pole moiety, where the heminephrectomy is risky or impossible. We present long-time experiences with this technique. Materials and methods: Retrospective evaluation of 35 patients after UPS done between 2011 and 2023. In 3 cases we performed surgery because of hydronephrosis of lower moiety in patients with incomplete duplication. Remaining cases (32) were operated because of complete duplication. With ectopic megaureter in 23 cases, with ectopic ureterocele in 9. Laparoscopic operation was recommended in children older than one year, minimally 10 kg, significant kidney dilatation, no reflux and preserved upper segment function. We evaluated age of patients, operating time, success rate, follow up and complications. Results: Median age was 29 (14-184) months, median operating time 210 (110-320) minutes. In all patients decreased or vanished upper tract dilatation. Median follow up was 18 (5-120) months. No reoperations were recorded. The most frequent complication was urinary leak from anastomosis in 7 (20%) cases. The reason was failure of urine diversion in 5 children (2 nephrostomy failure, ureteral catheter dysfunction in 3), remaining 2 patients were operated without urine diversion. Complications were resolved by ureteral catheter insertion in 3 and ureteral stent insertion in 4 cases. Conclusion: Laparoscopic UPS represents alternative mini-invasive method in duplex kidney anomalies treatment. It has high success rate and low rate of complications. The most frequent problem is urine leak from anastomosis. Therefore, the choice of reliable urine diversion is critical.
- Klíčová slova
- Zdvojení ledviny, uretero-pyeloanastomóza,
- MeSH
- anastomóza chirurgická * metody MeSH
- dítě MeSH
- diverze moči metody MeSH
- hydronefróza chirurgie etiologie MeSH
- laparoskopie * metody MeSH
- ledviny abnormality chirurgie embryologie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- stenty MeSH
- urogenitální abnormality * chirurgie embryologie MeSH
- urologické chirurgické výkony metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
BACKGROUND/PURPOSE: The standard treatment for boys with non-syndromic cryptorchidism is an early orchidopexy. It is unclear if surgical intervention alone is enough for future fertility. Recent studies show benefit of neoadjuvant or adjuvant hormonal treatment with gonadorelin (GnRH) for spermatogonia maturation based on testicular biopsy. The aim of this prospective study was to assess the safety of this treatment in infants with undescended testis at the recommended timing of early gonadorelin administration and timing of orchidopexy. METHODS: Unilateral cryptorchid full term boys were initially examined (including hormonal, physical and ultrasound examination) at the age of 2.5-3.5 months. At 6 months of age, cryptorchidism was confirmed. Those with non-syndromic cryptorchidism and palpable or sonographically detected testis were randomly assigned into two groups: with and without intranasal gonadorelin treatment. Inclusion criteria were met by 36 boys (21 in GNRH and 15 in the control groups). The following orchidopexy was performed before 12 months of age with repeated examination at time of surgery. Penile size and testicular volume (using ultrasound) and basal serum levels of LH, FSH, testosterone, Inhibin B and AMH were recorded at age of 3.0 (mean) months and 11.0 (mean) months (date of surgery). The stimulation hormonal levels were checked during GnRH administration. RESULTS: Between minipuberty (mean 3 months) and time of orchidopexy (mean 11 months of age) the penile size increased significantly and similarly in both groups. There was no significant difference in the change of the volume of descended testis between the groups nor of the volume of undescended testis. In addition, we did not find any significant difference in the change (drop) of hormonal levels of LH, FSH, Testosterone, Inhibin B and AMH (Table 1a) CONCLUSION: The neoadjuvant gonadorelin stimulation in infants with unilateral undescended testis has not shown any specific effect on the development of penile size, testicular volume and hormonal levels at time of orchidopexy in comparison with boys without stimulation, and in the mid-term, this treatment can be considered safe. Further follow-up is necessary to evaluate the long-term effect of this early treatment.
- MeSH
- folikuly stimulující hormon MeSH
- hormon uvolňující gonadotropiny MeSH
- kojenec MeSH
- kryptorchismus * farmakoterapie chirurgie MeSH
- lidé MeSH
- neoadjuvantní terapie MeSH
- prospektivní studie MeSH
- testis diagnostické zobrazování chirurgie patologie MeSH
- testosteron MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION AND OBJECTIVE: It is generally considered that artery sparing suprainguinal varicocelectomy is associated with a higher risk of persistence in comparison with the non-sparing (Palomo) procedure. Artery sparing is desirable in specific conditions. Based on our 21-year long experience, this study aims to describe technical details and standard steps of the procedure, leading to a comparatively low recurrence rate. MATERIAL AND METHOD: 336 patients, prospectively collected, who underwent laparoscopic lymphatic and artery-sparing microsurgical varicocelectomy as a primary operation between March 1999 and February 2020, were retrospectively evaluated. Patient age was 7-21.5 years (mean 15.4). The left side was involved in 313 (93.2%), both sides in 23 (6.8%) patients. In total 359 varicoceles were repaired, in which 281 cases were grade III, 65 grade II and 13 cases were grade I. The most common indications for surgery were left testicle hypotrophy, demonstrated in 167 (49.7%) patients, an abnormal spermiogram in 48 (14.2%), pain in 28 (8.3%) and bilateral involvement in 23 (6.8%) of patients. The technique has been standardized into four steps: early artery identification; peeling the network of small veins off the artery; peeling the lymphatic vessels off medium and large size veins and division of all veins; check of residual vascular bundle containing the artery and lymphatics only (video - Appendix A). Mean postoperative followup was 27.1 (range 0.5-174) months. Complications were recorded. Persistent varicocele was defined as clinically significant varicocele accompanied by renotesticular reflux on Doppler ultrasound. Ultrasound was used to rule out hydrocele formation and testicular atrophy. RESULTS: Persistent varicocele was recorded in 15 of 359 (4.2%) cases; secondary hydrocele was detected in 1 case (0.3%). Testicular atrophy was not detected in any of the operated patients. Most complications were recorded in the first 3 years after the introduction of the method; 5 recurrences of 290 (1.7%) cases were detected over the last 18 years (Table). DISCUSSION: The method meets all requirements of subinguinal microscopic repair. The artery preservation is desirable in previous (and for future) inguinal and subinguinal surgery cases where collaterals could be compromised. Artery sparing allows for a future vasectomy. Boys with a varicocele on a solitary testicle may be good candidates for this procedure as well. We consider the method as alternative for experienced laparoscopic surgeons. CONLUSION: The laparoscopic lymphatic and artery sparing microsurgical varicocelectomy is safe and effective method with a low recurrence rate like the non-sparing suprainguinal repairs.
- MeSH
- arterie MeSH
- dítě MeSH
- dospělí MeSH
- hydrokéla * chirurgie MeSH
- laparoskopie * metody MeSH
- lidé MeSH
- lymfatické cévy * chirurgie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- varikokéla * chirurgie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Meningomyelokéla je jednou z forem spina bifida a je popisována jako protruze míšního vaku obsahujícího mozkomíšní mok a neurální tkáň (obr. 1). Vzniká při nekompletním uzávěru páteřního kanálu v prvním měsíci těhotenství nejčastěji v lumbosakrální oblasti (obr. 2). Postižené děti jsou ohrožovány rizikem urologických komplikací v souvislosti s neurogenním močovým měchýřem. I v současnosti je jednou z častých příčin úmrtí u pacientů se spina bifida ledvinné selhání (1). Proto je nezbytné k zabránění urologických komplikací vyšetřit a léčit takto postižené děti ihned po narození a celoživotně o ně urologicky pečovat.
Myelomeningocele is one of the forms of spina bifida and described as a sac containing fluid and a neural tissue protruded from the back. It occurs when there is an incomplete closure of the spinal cord during the first month of pregnancy, most frequently in lumbosacral area. Afflicted children can be at high risk of urinary tract complication connected with neurogennic urinary bladder. Renal failure remains one of the most common causes of mortality in patients with spina bifida. Hence, to prevent the occurrence of neurogenic bladder and renal damage, a full urological examination and treatment after birth and continuous long-life urological care should be obtained.
- Klíčová slova
- ledvinné selhání,
- MeSH
- hyperaktivní močový měchýř terapie MeSH
- lidé MeSH
- meningomyelokéla * diagnóza komplikace patologie MeSH
- neurogenní močový měchýř diagnóza terapie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION: We found midline epithelial adhesions in the glandar urethral plate in patients with hypospadias. After dissolution, a blind epithelized channel becomes visualized inside of the plate pointing to immature embryonic luminization. In addition it reveals that the epithelized surface of the distal urethral plate is larger than previously considered. OBJECTIVE: To determine the incidence and extent of these new anatomical details of urethral plate in hypospadias patients. METHODS: We prospectively assessed the detailed anatomy of the urethral plate in 72 consecutive patients with hypospadias. We recorded the presence of adhesions in the middle of the glandar urethral groove that can be easily dissoluted (dissolution line - D-line). We recorded the plate width before and after D-line dissolution, the presence of the hidden blind channel at continuation of D-line (channel type-A) and of the visible blind channel between D-line and urethral hypospadiac meatus (type-B) (Figure). In 62 patients, where the urethral plate tubularization was considered (Duplay, TIP), septs between channels were opened in the midline and a final width of the plate was measured by rolling the plate around a tube. RESULTS: Midline adhesions (D-line) were found in all 72 patients. Mean length of D-line was 5.13 ± O.17 mm. Mean plate width before dissolution was 5.9 ± 0.15 mm, and after dissolution 7.8 ± 0.16 mm. A blind channel of type A was detected in 22 patients (31%), type B in 24 (33%), type A and B in 16 (22%), and none in 10 patients (14%). Mean final plate width after D-line dissolution and opening of septs between channels in 62 patients with urethral plate tubularization was 8.7 ± 0.15 mm. DISCUSSION: The main contribution of our study is a new perspective of distal urethral plate anatomy that enables enlargement of the epithelized surface of the distal urethral plate by dissolution of the preexisting epithelized groove and opening of epithelized channels within the plate. To the best of our knowledge, this anatomical anomaly has not been described previously. CONCLUSIONS: The distal urethral plate of all hypospadias patients is partially "folded" in the midline by epithelial adhesions of different depth and extent that may be easily dissoluted. In half of the patients (53%) the "folded" part of the plate continues proximally as a blind channel inside the urethral plate (type A channel). Opening of these structures together with the well-known urethral plate pits (type B channel) helps augment the width and the overall epithelized surface of the distal urethral plate.
- MeSH
- adheze tkání patologie MeSH
- hodnocení rizik MeSH
- hypospadie patologie chirurgie MeSH
- imunohistochemie MeSH
- jehlová biopsie MeSH
- kohortové studie MeSH
- kojenec MeSH
- kvalita života MeSH
- lidé MeSH
- novorozenec MeSH
- obnova funkce MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- uretra anatomie a histologie MeSH
- urologické chirurgické výkony u mužů metody MeSH
- věkové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Děti s vrozenými vadami se v současnosti dožívají dospělosti ve vyšších počtech než v minulosti. Pacienti s neurogenním měchýřem (NB) představují jedno z nejčastějších urologických onemocnění v této skupině. Vyžadují kontinuální celoživotní péči (Lifelong care), zaměřenou na úspěšný přechod pacienta do péče týmů, zabývajících se léčbou dospělých pacientů. Tyto týmy musí být seznámeny s klinickou problematikou péče o pacienty s NB ve všech věkových skupinách a musí být schopny zajistit komplexní péči. Dobře nastavená tranziční péče (TC) zajišťuje delší přežití a komfortnější život těchto pacientů v dospělosti.
Children with congenital anomalies are now entering adulthood in larger numbers than previously. Neurogenic bladder (NB) patients represent one of the most frequent urological diseases in this group. They require continuous, longlife care focusing on successful transfer of the patient to the care of adult‑centered teams. They must be familiar with clinical problems of NB in all age groups and be able to ensure complex follow up. Well designed transitional care (TC) results in increased survival and more comfortable lives of these patients in adulthood.
- Klíčová slova
- tranziční péče,
- MeSH
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- neurogenní močový měchýř * terapie MeSH
- vrozené vady MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
