Early Pyeloplasty for Recovery of Parenchymal Thickness in Children with Unilateral Ureteropelvic Junction Obstruction

Kim, Sun-Ouck; Yu, Ho Song; Hwang, In Sang; Hwang, Eu Chang; Kang, Taek Won; Kwon, Dongdeuk

doi:10.1159/000357144

Cited by 18 publications

(9 citation statements)

References 18 publications

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“…In another study, Kim and colleagues compared renal function before and after pyeloplasty in children with unilateral UPJO according to the children's age. They found surgical intervention before 1 year of age was a significant factor for recovery of PT [17]. Babu et al have shown that while renal function improves significantly in those undergoing early pyeloplasty, delayed surgery leads to marginal but significant loss of function.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome after neonatal pyeloplasty in antenatally diagnosed uretero-pelvic junction obstruction

2021

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Background With routine antenatal ultrasonography, fetal hydronephrosis is commonly diagnosed. This leads to early detection of postnatal uretero-pelvic junction obstruction which may require surgical intervention. But, there is no clear consensus in the benefits of operating these patients in the neonatal age. Methods Aim—To study the functional outcome after pyeloplasty in neonates with antenatally diagnosed unilateral uretero-pelvic junction obstruction (UPJO). Records of all neonates (N = 48) who presented between 2016 and 2018 with prenatal diagnosis of unilateral UPJO and underwent a Anderson-Hyne’s Pyeloplasty were retrospectively analyzed. Indications for surgery were SFU grade 3 or 4, a split renal function (SRF) < 40% on a diuretic renal scan and antero-posterior renal pelvic diameter (APD) > 2.5 cm with parenchymal thinning. Parenchymal thickness (PT) and APD measured by ultrasonography, and SRF measured by 99 m Tc-EC renal scan were compared before and after surgery. Results Our study comprised of 48 patients with 79.2% males (n = 38). UPJO affected the left side more (n = 30, 62.5%). The mean age at pyeloplasty was 28 days (range 26–30). The outcome was considered successful in 46 (95.84%) patients. The APD decreased from a mean of 3.5 cm APD preoperatively to 1.38 cm 1 year later which was statistically significant (p < 0.001). The PT increased from 3.95 to 7.1 mm 1 year postoperatively which was significant (p < 0.001). The drainage pattern and SRF improved in 46 (95.84%) patients. The SRF improved from a mean of 35.48–44.7% 1 year postoperatively which was significant (p < 0.001). Conclusion Pyeloplasty done in the neonatal age for prenatally diagnosed UPJO, having SFU grade 3–4 UPJO, leads to significant improvement of SRF and PT with minimal complications. Neonatal Pyeloplasty for significant UPJO is a safe procedure which provides the kidney maximum opportunity to improve function.

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Section: Discussionmentioning

confidence: 99%

Functional outcome after neonatal pyeloplasty in antenatally diagnosed uretero-pelvic junction obstruction

2021

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“…This question will remain a major challenge for the future. Actually, LP can duplicate the high success rates achieved with open pyeloplasty and within acceptable range duration, if performed by expert surgeons in centers with high laparoscopic expertise [26,27,28]. The LP procedure can be done through a transperitoneal approach or retroperitoneoscopically.…”

Section: Discussionmentioning

confidence: 99%

Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

Çiftçi

Akın²,

Savaş³

et al. 2016

Urol Int

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Objective: The aim of this study was to evaluate the long-term functional outcomes of laparoscopic pyeloplasty (LP) in children for consecutive cases of single institute. Materials and Methods: Our laparoscopy database was investigated for children in terms of LP between June 2008 and April 2015. All the patients had ureteropelvic junction obstruction (UPJO) and LP was performed. Demographic data including age, gender, side of UPJO, operation time, estimated blood loss (EBL), hospital stay and complications according to Clavien classifications were recorded. Renal ultrasonography and diethylenetriamine penta-acetate (DTPA) scintigraphies were respectively performed 3, 12 and 24 months after surgery. Statistical analyses were performed and p value was accepted as significant at <0.05. Result: Mean follow-up was 34 ± 4.7 months. The mean age was 13 (6-72) months. A total of 153 (110 boys and 43 girls) LP patients enrolled. Of that, 93 (60.78%) LP were in left side and 60 (39.21%) were in right side. Three cases needed open conversation according to difficulties in anastomosis. Aberrant crossing vessel was observed in 12 (7.84%) patients. The mean operation time was 155 ± 21 min and the mean EBL was 22 ± 11.1 ml. The mean hospital stay was 3.4 days. Anastomotic leakage was the common complication (in 13 patients) that was successfully managed conservatively (Clavien 1). Eight patients experienced unsuccessful LP and underwent open pyeloplasty (Clavien 3b). The mean split renal function significantly increased in DTPA scintigraphy in follow-up. The overall success was 91%. Conclusions: The LP procedure can be an effective and safe surgical method for childhood UPJO, specifically in the experienced hands of pioneer centers.

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“…UPJO is a major cause of end-stage renal disease, which affects millions of children worldwide, highlighting the urgent need for early surgical intervention. However, the optimal timing and indications for surgical intervention in asymptomatic children with UPJO are controversial (2)(3)(4)(5)(6), given the possibility of spontaneous improvement in most hydronephrosis cases. Investigators have proposed intensive imaging protocols during the initial non-surgical management of patients, including serial ultrasound and diuretic renography (7,8).…”

Section: Introductionmentioning

confidence: 99%

Matrix Remodeling-Associated Protein 5 in Urinary Exosomes as a Potential Novel Marker of Obstructive Nephropathy in Children With Ureteropelvic Junction Obstruction

et al. 2020

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Recent investigations have described the use of urinary matrix remodeling-associated protein 5 (MXRA5) as a novel biomarker of kidney impairment in the setting of chronic kidney disease. In this study, we aimed to evaluate the possible clinical application of urinary MXRA5 as a useful non-invasive marker in the urine from the affected renal pelvis and bladder of children with ureteropelvic junction obstruction (UPJO). We conducted a prospective cohort study of patients aged <12 months with prenatally diagnosed unilateral UPJO who underwent dismembered pyeloplasty in 2018 or 2019, and a sex-and age-matched control group of healthy children. Blood urea nitrogen and creatinine levels were normal in all the patients. The whole urine and urinary exosomal concentrations of MXRA5 were measured by enzyme-linked immunosorbent assay. The correlations between bladder/renal pelvic MXRA5 levels and differential renal function (DRF) in the affected kidney were also determined. A total of 35 UPJO patients and 12 controls were enrolled in the study. There was no significant difference in whole-urine MXRA5 level between the controls and UPJO patients. However, the exosomal MXRA5 level was significantly lower in the controls than in patients with UPJO (p < 0.05). There were non-significant correlations between bladder and renal pelvis whole-urine MXRA5 levels and DRF (R 2 = 0.1115, p = 0.05 and R 2 = 0.3313, p = 0.0502, respectively). The strongest correlation was between exosomal MXRA5 level in the renal pelvis and DRF (R 2 = 0.8128, p < 0.0001). Urinary exosomal MXRA5 level was significantly higher in children with UPJO than controls. Higher urinary exosomal MXRA5 levels were significantly correlated with lower DRF in the affected kidney in children with UPJO.

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Early Pyeloplasty for Recovery of Parenchymal Thickness in Children with Unilateral Ureteropelvic Junction Obstruction

Cited by 18 publications

References 18 publications

Functional outcome after neonatal pyeloplasty in antenatally diagnosed uretero-pelvic junction obstruction

Functional outcome after neonatal pyeloplasty in antenatally diagnosed uretero-pelvic junction obstruction

Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

Matrix Remodeling-Associated Protein 5 in Urinary Exosomes as a Potential Novel Marker of Obstructive Nephropathy in Children With Ureteropelvic Junction Obstruction

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