Role of Nephrostomy in poorly functioning kidneys in patients with ureteropelvic junction obstruction (UPJO)
Iranian Journal of Pediatric Surgery,
Vol. 5 No. 1 (2019),
15 June 2019
Introduction: Several studies have addressed the unique management challenges in poorly functioning kidneys of patients with ureteropelvic junction obstruction. Trial with percutaneous drainage of such kidneys as a guide to choose the type of surgical management would be a solution to this dilemma. We aimed to evaluate the role of percutaneous nephrostomy in treatment of poorly functioning kidneys in pediatric patients with UPJO.
Materials and Methods: A prospective study was performed on patients with poorly functioning kidneys (split renal function<10% on renal dynamic scan) and unilateral ureteropelvic junction obstruction from August 2016 to January 2018. Ultrasound-guided nephrostomy was inserted for these patients. Data regarding the differential renal function and glomerular function rate (GFR) was collected before and after nephrostomy insertion. Decision regarding pyeloplasty or nephrectomy of the involved kidney was made based on changes seen in differential function and Glomerular filtration rate following the drainage.
Results: Thirty three patients with unilateral UPJO with poorly functioning kidneys were treated during this period. Thirty patients had significant increase in differential function and glomerular filtration rate. These patients underwent pyeloplasty. In 2 patients, these parameters did not increase much and they underwent nephrectomy. One patient had an infected kidney which did not improve significantly on drainage and had to be removed. Of the 30 patients who had pyeloplasty, two developed obstruction after 3 months of removal of double-J stent and needed reoperation.
Conclusion: Percutaneous nephrostomy in poorly functioning kidneys with ureteropelvic junction obstruction helps to identify potentially salvageable kidneys which merit pyeloplasty. Kidneys which do not improve with nephrostomy are unlikely to improve with pyeloplasty and therefore nephrectomy is done in such cases.
- Ureteropelvic obstruction.
Duong HP, Piepsz A, Collier F, et al: Pedicting the clinical outcome of antenatally diagnosed unilateral pelviureteric junction stenosis. Urology 2013; 82:691-6.
Koff SA, Mutabagani KH: Anomalies of the kidney. In: Gillenwater JY, Grayhack JT,Howards ss, Mitchell ME,editors. Adult and Pediatric Urology.4th. Philadelphia, Pa, USA: Lipincott Williams and Wilkins;2002.pp2129.
Chertin B, Pollack A, Koulikov D, et. Al: Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16years offollow-up. Eur Urol 2006;49:734-8.
Pickard R: Which surgery is ‘best’ for patients with PUJ obstruction in a poorly functioning kidney? Indian J Urol 2007;23:12-3.
Singh A, Bajpai M, Panda SS, et al: Role of Percutaneous nephrostomy in poorly functioning kidney due to pelviureteric junction obstruction in older children. Journal of Progress in Paediatric Urology 2013; 16:46-9.
Gupta DK, Chandrasekharam VVSS, Srinivas M, et al: Percutaneous nephrostomy in children with ureteropelvic junction obstruction and poor renal function. Urology 2001; 57:547-50.
Irving HC, Arthur RJ, Thomas DF: Percutaneous nephrostomy in paediatrics. Clin Radiol 1987;38:245-8.
Wagner M, Mayr J, Hacker F-M: Improvement of renal split function in hydronephrosis with less than 10% function. European Journal of Pediatricsurgery 2008; 18:156-9.
Pode D, Shapiro A, Gordon R, et al: Percutaneous nephrostomy for assessment of functional recovery of obstructed kidneys. Urology 1982;19:482-5.
Zhang S, Zhang Q, JI C, et al: Improved split renal function after Percutaneous nephrostomy in young adults with severe hydronephrosis due to ureteropelvic junction obstruction. The journal of urology 2015; 193:191-5.
Comploj E, Becker T, Koen M, et al: Does a Preoperative Percutaneous Nephrostomy Influence the Outcome of Pyeloplasty in Infants and Children. Curr Urol 2009; 3:174-8.
- Abstract Viewed: 147 times
- PDF Downloaded: 50 times