Safety and Efficiency of Pyeloplasty in The First Six Weeks of Infants' Life
Urology Journal,
Vol. 18 No. 01 (2021),
17 March 2021
,
Page 81-85
https://doi.org/10.22037/uj.v18i01.5531
Abstract
Purpose: The aim of this study was to assess the safety and the efficiency of pyeloplasty in infants with ureteropelvic junction obstruction (UPJO) in the first six weeks of their life.
Materials and Methods: Clinical records of the patients who had surgery during first six weeks of life for UPJO
between June 2009 and June 2014 were analysed retrospectively.
Results: In this period, twenty-six dismembered pyeloplasties were performed in twenty-four patients on mean
operation age of 27.3 ± 10.2 days (range 8-42 days). On the first postnatal ultrasound all twenty-six renal units had SFU-4 hydronephrosis. Mean preoperative and postoperative anterior-posterior pelvic diameter and parenchymal thickness were 33.1 ± 8.9mm (range 14-49mm), 3.2 ± 1mm (range 1-4,6mm) and 14.7 ± 6.6mm (range 6-27mm) and 7.8 ± 1.9mm (range 3.0-10.4mm), respectively. The differences between preoperative and postoperative parenchymal thickness and anterior-posterior pelvic diameter were statistically significant (P ˂ 0.0001). Preoperative MAG3 dynamic renal scintigraphy showed obstructive pattern on the diuretic renogram in 26 units. Mean preoperative and postoperative differential renal function on dynamic renal scintigraphy of the affected renal units were 46 ± 15 and 44 ± 15, respectively. Postoperative drainage was normal on dynamic renal scintigraphy in 25 (96.2%) of the 26 units, redo-pyeloplasty was needed in only one unit (3.8%).
Conclusion: In conclusion, patient selection and timing of surgery are very important in the protection of renal
function in newborn with UPJO. In our opinion, if there is indication for surgery, early surgical intervention should not postpone in this period. Surgical treatment of UPJO during first six weeks of life is safe and effective.
- Ureteropelvic junction obstruction
- pyeloplasty
- newborn
How to Cite
References
Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010; 6: 212-31.
Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: Introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993; 23: 478- 80.
Onen A. An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis. J Pediatr Urol 2007; 3: 200-5.
Karnak I, Woo LL, Shah SN, Sirajuddin A, Ross JH. Results of a practical protocol for management of prenatally detected hydronephrosis due to ureteropelvic junction obstruction. Pediatr Surg Int 2009; 25: 61-7.
Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 1990; 144: 584-7.
Arnold AJ, Rickwood AM. Natural history of pelviureteric obstruction detected by prenatal sonography. Br J Urol 1990; 65: 91-6
Madden NP, Thomas DF, Gordon AC, Arthur RJ, Irving HC, Smith SE. Antenatally detected pelviureteric junction obstruction. Is non-operation safe? Br J Urol 1991; 68: 305-10.
Ulman I, Jayanthi VR, Koff SA. The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol 2000; 164: 1101-5.
Heinlen JE, Manatt CS, Bright BC, Kropp BP, Campbell JB, Frimberger D. Operative versus nonoperative management of ureteropelvic junction obstruction in children. Urology 2009; 73: 521-5.
Subramaniam R, Kouriefs C, Dickson AP. Antenatally detected pelvi-ureteric junction obstruction: concerns about conservative management. BJU Int 1999; 84: 335-8.
Hanna MK. Antenatal hydronephrosis and ureteropelvic junction obstruction: the case for early intervention. Urology 2000; 55: 612-5.
Babu R, Rathish VR, Sai V. Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi-ureteric junction obstruction. J Pediatr Urol 2015; 11: 63.e1-5.
O’Reilly PH, Consensus Committee of the Society of Radionuclides in Nephrourology. Standardization of the renogram technique for investigating the dilated upper urinary tract and assessing the results of surgery. BJU Int 2003; 91: 239-43.
Lupton EW, Testa HJ, O'Reilly PH, Gosling JA, Dixon JS, Lawson RS, et al. Diuresis renography and morphology in upper urinary tract obstruction. Br J Urol 1979; 51: 10-14.
Eskild-Jensen A, Gordon I, Piepsz A, Frøkiaer J. Interpretation of the renogram: problems and pitfalls in hydronephrosis in children. BJU Int 2004; 94: 887-92.
Palmer LS, Maizels M, Cartwright PC, Fernbach SK, Conway JJ. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol 1998; 159: 222-8.
Ozcan Z, Anderson PJ, Gordon I. Robustness of estimation of differential renal function in infants and children with unilateral prenatal diagnosis of a hydronephrotic kidney on dynamic renography: How real is the supranormal kidney? Eur J Nucl Med Mol Imaging 2006; 33: 738-44.
Gungor F, Anderson P, Gordon I. Effect of the size of regions of interest on the estimation of differential renal function in children with congenital hydronephrosis. Nucl Med Commun 2002; 23: 147-51.
Kajbafzadeh AM, Tourchi A, Nezami BG, Khakpour M, Mousavian AA, Talab SS. Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants. J Pediatr Urol 2011; 7: 283-8.
Turner RM 2nd, Fox JA, Tomaszewski JJ, Schneck FX, Docimo SG, Ost MC. Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants. J Urol 2013; 189: 1503-7.
Braga LH, Lorenzo AJ, Bägli DJ, Keays M, Farhat WA, Khoury AE, et al. Risk factors for recurrent ureteropelvic junction obstruction after open pyeloplasty in a large pediatric cohort. J Urol 2008; 180: 1684-7.
Morsi HA, Mursi K, Abdelaziz AY, Elsheemy MS, Salah M, Eissa MA. Renal pelvis reduction during dismembered pyeloplasty: is it necessary? J Pediatr Urol 2013; 9: 303-6.
Almodhen F, Jednak R, Capolicchio JP, Eassa W, Brzezinski A, El-Sherbiny M. Is routine renography required after pyeloplasty? J Urol 2010; 184: 1128-33.
- Abstract Viewed: 177 times
- 5531/pdf Downloaded: 135 times