Landa JS, Maldonado AW, Hernández AG, Zaldivar CJ, Zepeda SJT, Velázquez OJ

Language: Spanish
References: 20
Page: 32-38
PDF size: 275.66 Kb.

ABSTRACT

Introduction: Obstruction of uretero-pelvic junction is the most common etiology of hydronefrosis in children. The objective of this study is analyze clinical presentation, diagnosis, treatment and expose standards of diag-nosis and management of this pathology.
Material and methods: This is a retrospective study of 175 children with uretero-pelvic junction obstruction, treated over a period of 13 years. The analyzed data were: Age at initial presentation, sex, side affected, signs and symptoms, associated congenital anomalies, transient procedures done prior to definitive treatment, diagnosis workup, type of reconstruction, complications and final outcome.
Results: There were 105 left, 46 right and 24 bilateral kidneys affected for a total of 199. Treatment consisted of an Anderson-Hynes pieloplasty in 92%, reinter-vention or balloon dilatation in 3.5% and simple nephrectomy in the rest (4.5%). The final outcome was considered good in 91.9% and bad in 8.1% patients (-1 year age), nefrostomy was employed by renal function -10% and the others pieloplasty. In all of them the renal function improved between 10 and 20%.
Conclusion: With detection and early management we have kidneys unaffected. The surgery, in patients -1 year age, improved the renal function, and in olders only the lesion will be limited.

REFERENCES

1. Johnaton JH, Evans G et al. Pelvic hydronephrosis in children: A review of 219 personal cases. J Urol 1987; 117: 97-101.

2. Koff SA. Pathophysiology of ureteropelvic junction obstruction. Clinical and experimental observations. Urol Clin North Am 1990; 17: 2.

3. Koff SA. The diagnosis of obstruction in experimental hydronephrosis. Mechanics for progressive urinary dilation. Invest Urol 1981; 19: 85.

4. Koff SA. Determinant of progression and equilibrium in hydronephrosis. Urol 1983; 21: 496.

5. Retik AB, Bernstein GT, Bauer SB et al. Ureteropelvic junction obstruction in the neonate. J Urol 1988; 140(5): 1216.

6. Roth DR, González et al. Management of ureteropelvic junction obstruction in infants. J Urol 1983; 129(1): 108.

7. Hendre HW, Radhakrishnan J. Pediatric pieloplasty. J Ped Surg 1980; 15: 133.

8. Drake DP, Stevens PS et al. Hydronephrosis secondary to ureteropelvic junction obstruction in children. A review of 14 years. J Urol 1978; 119: 649.

9. Roberts JB, Slide. The natural history of primary pelvic junction hydronephrosis. Br J Surg 1964; 51: 759.

10. Whittier RH. The Whittier test. Urol Clin North Am 1979; 6: 529.

11. Koff SA et al. Diuretic radionuclide urography. A non invasive method of assessing nephroureteral dilatation. J Urol 1979; 122: 451.

12. Hoyt HS. Equilibrium in hydronephrosis. Standfor Med Bull 1954; 12: 71.

13. Olsen PR. The renal pelvis and ureteral peristalsis pelvymetry. Scand J Urol Nephrol 1979; 13: 269.

14. Williams DM et al. The prognosis of pelviureteric obstruction in childhood. Eur Urol 1976; 2: 57.

15. Kelalis PP, Culp QS. Ureteropelvic obstruction in children. Experiences with 109 cases. J Urol 1971; 106: 418.

16. Koff SA, Campbell KD. The nonoperative management of unilateral neonatal hydronephrosis. Natural history of poorly functioning kidneys. J Urol 1994; 152: 593-595.

17. Duckett JW. When to operate on neonatal hydronephrosis. Urol 1993; 42 (6): 617-619.

18. Tan HL, Roberts JP. Laparoscopic dismembered pyeloplasty in children. Preliminary results. Br J Urol 1996; 77: 909-911.

19. Ho DS et al. Ureteropelvic junction obstruction in upper and lower moiety of duplex renal systems. Urol 1994; 45(3): 503-506.

20. Streem SB et al. Uretoropelvic junction obstruction. Urol Clin North Am 1998; 25(2): 361.