Functional results of pyeloplasty performed in infancy

Czech version

Authors: Jan Šarapatka; Oldřich Šmakal; Jan Vrána
Authors‘ workplace: Urologická klinika LF UP a FN Olomouc
Published in: Ces Urol 2017; 21(2): 147-153
Category: Original Articles

Overview

Aim:
The aim of this study was to evaluate the effectiveness of early pyeloplasty by comparing pre-operative and post-operative ultrasound (US) and radionuclide findings in a group of children undergoing surgery for ureteropelvic junction obstruction (UPJ) in the first year of life, with a group of children undergoing surgery later in life.

Method:
A prospective evaluation of a group of children who underwent surgery for UPJ obstruction between 2004–2012 at University Hospital Olomouc was made. 190 children underwent surgery, of which 110 during the first year of life (group 1) and 80 children above the age of 1 (group 2). US parameters (kidney length, anteroposterior renal pelvis diameter, parenchymal thickness) and radionuclide findings (split renal function, UPJ obstruction) before surgery and in the 1^st, 2^nd and 3^rd year after surgery were monitored. Statistically, the parameters in each group with contralateral healthy kidneys and between individual groups were analysed.

Results:
Group 1 showed a percentage increase, compared with group 2: of 26 % / 11% respectively in the length of kidney, 200 % / 94.7 % in parenchyma, and 6.7 % / 2 % in kidney function. In both groups the reduction in ureteropelvic dilation was comparable.

Conclusion:
The results of the study confirm the effectiveness of pyeloplasty conducted in early infancy. In this group of children there was more significant post-operative increase in kidney length, kidney parenchyma and kidney function in comparison with the group of older children.

KEY WORDS:
Hydronephrosis, pelvi-ureteric junction obstruction, pyeloplasty.

Sources

1. Lee, Richard S, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta‑analysis. Pediatrics 2006; 118(2): 586–593.

2. Koff SA, Campbell KD. The nonoperative management of unilateral neonatal hydronephrosis: natural history of poorly functioning kidneys. The Journal of urology 1994; 152(2): 593–595.

3. 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. Pediatric surgery international 2009; 25(1): 61–67.

4. Ulman I, Javanthi VR, Koff SA. The long‑term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. The Journal of urology 2000; 164(3): 1101–1105.

5. Chertin B, Pollack A, Koulikov D, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow‑up. European urology 2006; 49(4): 734–739.

6. 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(3): 521–525.

7. Kim SO, Yu HS, Hwang IS, Hwang EC, Kang TW, Kwon D. Early pyeloplasty for recovery of parenchymal thickness in children with unilateral ureteropelvic junction obstruction. Urologia internationalis 2014; 92(4): 473–476.

8. Babu R, Rathish VR, Sai V. Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi‑ureteric junction obstruction. Journal of pediatric urology 2015; 11(2): 63–e1.

9. Jiang D, Tang B, Xu M. Functional and morphological outcomes of pyeloplasty at different ages in prenatally diagnosed society of fetal urology grades 3–4 ureteropelvic junction obstruction: is it safe to wait? Urology 2016.10. http://uroweb.org/guideline/paediatric‑urology/

11. Šmakal O, Šarapatka J, Flögelová H, Bakaj Zbrožková L. Je vhodné podávat ATB profylaxi kojencům se závažnou hydronefrózou před provedení pyeloplastiky? Ces Urol 2013; 17(3): 193–198.

12. Vemulakonda VM, Wilcox DT, Crombleholme TM, Bronsert M, Kempe A. Factors associated with age at pyeloplasty in children with ureteropelvic junction obstruction. Pediatric surgery international 2015; 31(9): 871–877.