Surgical treatment of pediatric ureteropelvic junction obstruction: A single center experience
Sabri Cansaran1
, Ayşenur Celayir2, Oktav Bosnalı2, Osman Zeki Pektaş2
1Tokat Devlet Hastanesi, Tokat, Türkiye
2İstanbul Zeynep Kamil Kadın ve Çocuk Hastalıkları Sağlık Uygulama ve Araştırma Merkezi, İstanbul, Türkiye
Keywords: Ureteropelvic junction obstruction, hydronephrosis, pyeloplasty, ultrasound, diuretic renogram
Abstract
Objective: Ureteropelvic junction obstruction (UPJO) is a partial or intermittent total occlusion occurring at the junction of renal pelvis and ureter. The aim of this study was to evaluate the longterm results of patients with UPJO who underwent open pyeloplasty in our clinic.
Method: Records of 102 patients who were operated due to UPJO between January 2004 and 2015, 102 were evaluated retrospectively in terms of gender, laterality, diagnostic method and age at diagnosis, follow-up period, ultrasonographic features, renal scintigraphy findings, age and characteristics of operation, technique and materials used, and postoperative follow-up period.
Results: Within 28 female, and 74 male patients were operated. The patients had left- (n=67), rightsided (n=28), and bilateral (n=7) UPJOs. Seventy-two patients were diagnosed during antenatal period. The average age of diagnosis was 4.1 years in other 30 patients. During the preoperative ultrasound examination, the average ipsilateral pelvic anterior-posterior (PAP) diameter was 30.3 mm and parenchymal thickness 5.6 mm. The average ipsilateral PAP diameter was 16.4 mm and parenchymal thickness was 10 mm in postoperative 1st year ultrasonographic examination. In scintigraphy, results of pre-, and post-operative average differential (split) renal function tests were 44% and 45%, respectively. The mean age at surgery was 2 years (7 days-14.8 years). Double-J stents (DJS) were used in 94 kidneys. While no catheter was used in 5 kidneys, pyelostomy catheters were inserted in 10 kidney, and removed s within 7-15 days. DJSs were removed without any problem with the aid of a cystoscope in 82 (87%) kidneys. One of them came out of the urethra spontaneously. Eight stents migrated from urinary bladder into ureter were taken with the aid of ureterotomy or ureteroscopy. Three stents in two patients who underwent surgery for bilateral and left ureterovesical junction obstruction were removed during ureteroneocystostomy. The average follow-up period of the patients was 4.4 years. Only 5 (4.5%) of 109 renal units with UPJO had recurrence.
Conclusion: Dismembered pyeloplasty is a very successful surgical option in the treatment of UPJO and has a low recurrence rate. Complications of DJS may cause additional morbidity.
Atıf vermek için: Cansaran S, Celayir A, Bosnalı O, Pektaş OZ. Pediatrik üreteropelvik bileşke obstrüksiyonunda cerrahi tedavi: Tek merkez deneyimi. Çoc. Cer. Derg. 2019;33(2):72-8.