A RARE CASE OF BILATERAL OBSTRUCTIVE MEGAURETER WITH A GIANT URETRAL URETEROCELE ON THE LEFT

Abstract

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

Keywords

ureterocele / ureter ectopia / extravesical ureterocele

References

[1] Николаев В.В, Абдуллаев Ф.К, Кулаев В.Д, Гусейнов А.Я. Уретероцеле у детей. Детская хирургия. 2007;4: 35-8.

[2] Абдуллаев Ф.К., Кулаев В.Д., Николаев В.В. Патогенез сопутствующей патологии верхних мочевых путей у детей с эктопическим уретероцеле. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013; 3(3): 12-8.

[3] Румянцева Г.Н., Королькова И.А. Удвоенная почка у детей, учеб. пособие. Тверь: Риц ТГМА; 2006.

[4] Соснин Е.В. Внутрипузырная и внепузырная эктопия устьев мочеточников при удвоении почек у детей: автореф. дис. … канд.мед.наук: 14.00.35. Е.В. Соснин; С-петербург. гос.педиатр.мед.акад.СПб: 1997.

[5] Stephens D.: Caecoureterocele and concepts on the embryology and aetiology of ureteroceles. Aust. N. Z. J. Surg. 1971; 40 (3): 239-48.

[6] Glassberg K.I., Braren V., Duckett J.W. (et al.) Suggested Terminology for Duplex Systems, Ectopic Ureters and Ureteroceles. The Journal of Urology. 1984; 132(6): 1153-4.

[7] Лопаткин И.А. Руководство по урологии. М.: Медицина. 1998

[8] Berrocal T., Lopez-Pereira P., Arjonilla A., Cutierres J. Anomalies of the distal ureter, bladder and urethra in children: embryologic, radiologic and pathologic features. Radiographics. 2002; 22 (5): 1139-64.

[9] Merlini E., Lelli C.P. Obstructive ureterocelean ongoing challenge. World J. Urology. 2004; 22 (2): 107-14.

[10] Ziylan O., Oktar T., Korgali E., Nane I., Alp T., Ander H. Lower urinary tract reconstruction in ectopic ureteroceles. J.Urol. 2005; 74(2): 123-6

[11] Джавад-Заде М.Д., Джавад-Заде С.М., Гусейнов Э.Я. Лечение уретероцеле у детей. Урология. 2005; 3: 47-51

[12] Merguerian P.A, Byun E., Сhang B. Lower urinary tract reconstruction for duplicated renal units with ureterocele. Is excision of the ureterocele with reconstruction of the bladder base necessary? J Urol. 2003; 170 (4 pt.2): 1510-13.

[13] Gran C.D., Кгорр B.P., Cheng E.Y., Kropp K.A. Primary lower urinary tract reconstruction for nonfunctioning renal moieties associated with obstructing ureteroceles. J Urology. 2005; 173(1): 198-201.

[14] Румянцева Г.Н. Хирургические формы удвоенной почки у детей, диссертация на соискание ученой степени кандидата мед. наук. 1974