İdrar inkontinasının nadir nedeni olan ektopik üreter tanısında anamnezin yeri ve tedavisinde minimal invaziv cerrahi uygulaması
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Date
2020-11-23
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Bursa Uludağ Üniversitesi
Abstract
Bu olgu sunumunun amacı idrar kaçırma şikayeti ile başvuran kız çocuklarında ayrıntılı anamnez ile ektopik üreter tanısı konması ve minimal invaziv yöntemle tedavi edilerek şifa sağlanması konusunda bilgi vermektir.11 yaşında kız hasta, tuvalet eğitiminin tamamlanmasından beri olan, idrar kaçırma şikayetiyle başvurdu. Hasta daha önce farklı merkezlerde birçok defa muayene edilmiş ve işeme disfonksiyonu tanısıyla tedavi edilmiş. Fakat tedaviden fayda görmemişti. Anamnezinde sürekli idrarı kaçırması mevcuttu. Urgency bulgusu yoktu. Fizik muayenede herhangi bir orta hat defekti saptanmadı. Yapılan üroflowmetri testinde patolojik bulgu yoktu. Hastanın üriner sistem ultrasonografi tetkikinde patolojik bulgu yoktu. Bu bulgular ışığında ektopik üreter olasılığı düşünülerek Manyetik Rezonans (MR) Ürografi istendi. MR Ürografi tetkikinde; sol böbrek üst polünün displastik görünümde olduğu, üst polü drene eden üreterin geniş olduğu ve sol üreterin vajina üst-arka duvarına ektopik olarak açıldığı görüldü. Statik Böbrek Sintigrafisi (DMSA) tetkikinde; sol böbrek üst poldeki displastik alanın nonfonksiyone olduğu görüldü. Bu bulgular sonucunda hastaya laparoskopik parsiyel nefrektomi + üreterektomi yapıldı. Ameliyat süresi 120 dakika, tahmini kan kan kaybı 40 ml olarak tespit edildi. Hastanın postoperatif birinci gününde sondası, ikinci gününde dreni çekilerek hasta şifa ile taburcu edildi. Ameliyat spesmeninin patoloji sonucu displastik böbrek ile uyumlu idi. Postoperatif 15. gün, 1. ve 3 aydaki kontrol muayenelerinde, hastanın inkontinans şikayetlerinin tamamen geçtiği görüldü. Sonuç olarak idrar kaçırma şikayeti ile başvuran hastalarda tedaviye yanıt yoksa, ayırıcı tanıda ektopik üreter mutlaka düşünülmelidir. Tedavisinde başarı oranı yüksek ve minimal invaziv bir yöntem olan laparoskopi tercih edilmelidir.
The aim of this case report is to share a pediatric case with ectopic ureter opening into the vagina, which is a rare cause of medical treatment resisted female urinary incontinence and its minimally invasive treatment method. An 11-year-old girl presented with true urinary incontinence since her toilet training was completed. The patient had been treated medically many times in different centers before, but didn’t benefit from the treatment. There was no pathological finding in physical examination, uroflowmetry and ultrasonography. MRI urography was planned in the differential diagnosis considering the ectopic ureter opening into the genital system. It was observed that the upper pole of the left kidney was dysplastic and the ureter draining the upper pole was opened ectopically to the upper-posterior wall of the vagina. In Static Kidney Scintigraphy (DMSA) examination; it was observed that the dysplastic area in the left kidney was nonfunctional. As a result of these findings, laparoscopic partial upper pole nephrectomy + ureterectomy was performed. The foley catheter was removed on the first postoperative day and the drainage catheter was removed on the second day. The patient was discharged on the second postoperative day. In the postoperative 15th day, 1st and 3rd month follow-up examinations, it was observed that the patient's incontinence completely disappeared. In conclusion, Ectopic ureter should be kept in mind as differential diagnosis in cases of urinary incontinence resistant to medical treatment and Laparoscopic partial nephrectomy should be preferred for treatment as a minimally invasive method with a high success rate.
The aim of this case report is to share a pediatric case with ectopic ureter opening into the vagina, which is a rare cause of medical treatment resisted female urinary incontinence and its minimally invasive treatment method. An 11-year-old girl presented with true urinary incontinence since her toilet training was completed. The patient had been treated medically many times in different centers before, but didn’t benefit from the treatment. There was no pathological finding in physical examination, uroflowmetry and ultrasonography. MRI urography was planned in the differential diagnosis considering the ectopic ureter opening into the genital system. It was observed that the upper pole of the left kidney was dysplastic and the ureter draining the upper pole was opened ectopically to the upper-posterior wall of the vagina. In Static Kidney Scintigraphy (DMSA) examination; it was observed that the dysplastic area in the left kidney was nonfunctional. As a result of these findings, laparoscopic partial upper pole nephrectomy + ureterectomy was performed. The foley catheter was removed on the first postoperative day and the drainage catheter was removed on the second day. The patient was discharged on the second postoperative day. In the postoperative 15th day, 1st and 3rd month follow-up examinations, it was observed that the patient's incontinence completely disappeared. In conclusion, Ectopic ureter should be kept in mind as differential diagnosis in cases of urinary incontinence resistant to medical treatment and Laparoscopic partial nephrectomy should be preferred for treatment as a minimally invasive method with a high success rate.
Description
15. Türk Çocuk Ürolojisi Kongresi’nde (29 Kasım - 01 Aralık 2019, Antalya) sözlü bildiri olarak sunulmuştur.
Keywords
İdrar kaçırma, Ektopik üreter, Laparoskopi, Displastik böbrek, Urinary incontinence, Minimal invaziv tedavi, Dysplastic kidney, Ectopic ureter, Minimally invasive treatment, Laparoscopy
Citation
Aydın, Y. M. vd. (2020). ''İdrar inkontinasının nadir nedeni olan ektopik üreter tanısında anamnezin yeri ve tedavisinde minimal invaziv cerrahi uygulaması''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 46(3), 399-402.