Ureteropelvic Junction Obstruction: The Effect of Pyeloplasty on Renal Function

Dowling, Keith J.; Harmon, Edwin; Ortenberg, Joseph; Polanco, Edgar; Evans, Blackwell B.

doi:10.1016/s0022-5347(17)42008-8

Cited by 51 publications

(11 citation statements)

References 17 publications

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“…Assuming that the earlier the obstruction is released the better the function after surgery [9], it might also seem logical that the younger the patient at surgery the better the resulting function. Eight studies analysed the effect of age at surgery on final DRF [7,11,14,15,17,24,27,31]. Seven reported that age does not affect the eventual functional outcome for both prenatal and postnatal HN [7,11,14,15,17,24,31].…”

Section: Resultsmentioning

confidence: 99%

Scintigraphic renal function after unilateral pyeloplasty in children: a systematic review

et al. 2008

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OBJECTIVE To systematically review previous reports and thus determine the functional outcome after pyeloplasty in children with unilateral hydronephrosis due to pelvi‐ureteric junction obstruction, and the possible variables that could affect it. METHODS We searched Medline/PubMed, Embase, and Web of Science for articles in English published from 1966 to 2007, using both ‘medical subject headings’ and ‘free text’ protocols. Abstracts, full texts, and bibliographies of pertinent papers were reviewed to select studies of scintigraphic renal function before and after pyeloplasty. The postoperative change in scintigraphic renal function was assessed in relation to presentation (antenatal vs postnatal), timing of surgery (early vs delayed), age at surgery, and preoperative ultrasonography (US) and scintigraphic findings. RESULTS Thirty‐six studies (2.1% of the initial search) were eventually selected for review. Studies were generally of poor scientific quality and very heterogeneous in their indications for surgery and follow‐up protocols. Postoperative function showed a wide variability. Symptomatic patients diagnosed postnatally seemed to have a greater chance of functional improvement after surgery than asymptomatic patients diagnosed antenatally. The chance of improvement seemed also to be greater in patients with moderately rather than severely impaired preoperative function. Otherwise, the improvement seemed unrelated to the age at surgery, the preoperative US findings, or the excretion pattern on renal scintigraphy. Of patients having delayed surgery >97.5% had preserved function afterward. CONCLUSIONS Patients with moderately impaired preoperative function and those diagnosed postnatally because of symptoms are those with the greatest likelihood of having a functional improvement after surgery.

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Section: Resultsmentioning

confidence: 99%

Scintigraphic renal function after unilateral pyeloplasty in children: a systematic review

et al. 2008

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“…The clinical results are evaluated on the basis of symptomatic relief, improvement or stabilization of renal function and absence of recurrent infection and urinary lithiasis. Review of pyeloplasty series did not show any correlation between the anatomic appearance of the col lecting system and the clinical indicators [6][7][8][9][10][11]. Radio logical assessment of the outcome of pyeloplasty is based on the appearance of the pelvicocaliceal system and the demonstration of early passage of contrast medium through the upper ureter [6,7], Successful pyeloplasty is characterized either by radio logical improvement of the pelvicocaliceal drainage or an unchanged dilated system without evidence of deteriora tion with early demonstration of the upper ureter.…”

Section: Discussionmentioning

confidence: 99%

Ureteropelvic Junction Obstruction: Relation of Etiology and Age at Surgical Repair to Clinical Outcome

Raviv

Leibovitch²,

Shenfeld³

et al. 1994

Urol Int

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Ureteropelvic junction (UPJ) obstruction is a congenital anomaly either caused by intrinsic narrowing of the upper ureter or by extrinsic pressure on the ureter caused by aberrant vessels or fibrous bands. We reviewed 121 cases of pyeloplasties performed in our department for UPJ obstruction. The cases were grouped by age and by the underlying pathology. Postoperative urographic evaluation showed that dismembered pyeloplasty was successful in 98.4% of the patients, with no significant difference between age groups. Persistence or recurrence of preoperative symptoms occurred in some patients (16.6%). Extrinsic obstruction of the ureter was associated with better postoperative clinical results and less recurrence of symptoms.

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“…Patient age has been depicted as the single most important factor governing the improvement in function following pyeloplasty [8] apart from the presence or absence of infection. Most workers [9] believe that repair should be made as early as possible preferably before the age of 1 year since maturation of renal function is more rapid in the first 6 months of life and levels off at 2 years.…”

Section: Resultsmentioning

confidence: 99%