ABSTRACT
Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male children with associated sequlae. Different factors, such as age at presentation, initial and nadir serum creatinine, renal parenchymal echogenicity on initial USG, vesicoureteric reflux (VUR) , recurrent UTI, bladder dysfunction and the presence or absence of pop-off mechanism like VURD have significant impact on ultimate renal outcome. The main aim of the study was to observe the effects of different prognostic factors like age of presentation and preoperative VUR of the PUV respondents on postoperative long term renal outcome as well as changes of renal function status on the basis of initial and postoperative serum creatinine level in our settings. Material & Methods: This was a quasi-experimental study and conducted in the Department of Pediatric urology of Bangladesh Shishu Hospital and Institute, Dhaka. We enrolled 58 male children of different ages having posterior urethral valve, who were admitted in the pediatric urology department from July,2018 to Dec,2021. Results: Total 58 patients included in our study. Among all patients 53.4% were aged between 1 month to 1 year, 39.7% of them were more than 1 year old and 6.9% of them were neonates. Among 31 respondents, 32.3 % had poor renal function & 35.5 % of them also had moderately impaired renal function. Again, out of 23 respondents, 30.4% had poor renal function & 6% had moderately impaired renal function. The relation between age category and postoperative renal function status (On the basis of postoperative eGFR) of the posterior urethral valve respondents were statistically not significant. Patients who had no VUR, 66.7% of them had normal renal function, 25% had moderately impaired renal function and 8.3% had poor renal function. Respondents who had bilateral VUR, 55% of them had poor renal function and 35% had moderately impaired renal function. Among respondents who had unilateral VUR, 28.6% of them had poor renal function and 28.6% had moderately impaired renal function but 42.9% had normal renal function. The relation between preoperative VCUG findings and postoperative long term renal function status of the PUV patients were statistically significant. 7 (100%) respondents who had preoperative abnormal renal function, more than 71.4% of them had returned to normal renal function after operative procedure. But abnormal renal function was present in 2 (28.6%) patients during follow up. In our study we found 29.3% of our patients had poor renal outcome and 29.3% patients had moderately impaired renal function within the mean follow up period of 19.33±12.38 months (ranges from 9months to 4 years). Conclusion: Our research highlights the significance of age at presentation, despite its statistically negligible effect on long-term renal outcomes. However, among the children with PUV following valve ablation and with a long-term follow-up, beginning serum creatinine and the presence of various types of VUR on initial VCUG had a significant effect (p.05) on postoperative renal function on the basis of serum creatinine.
ABSTRACT
Background: Hydronephrosis is a major urological health problem in children. Pelviretic junction (PUJ) obstruction is common among the congenital causes of hydronephrosis. A-H pyeploplasty is the most popular and common technique. There are different modalities of using trans-anastomotic stent in A-H pyeloplasty. Some surgeons use external drainage like nephrostomy tube, pyelostomy tube or trans-anastomotic stent and others use internal drainage D-J stent. In this study, D-J stent and BMI feeding tube were used for trans anastomotic drainage. We analyzed the data to find out which method of stenting in A-H pyeloplasty is more effective and safer and also to reduce the morbidity by reducing stent related complications.Material & Methods:A prospective interventional study was conducted in the faculty of Paediatric Surgery inBangladesh Shishu Hospital and Institute during the period from January 2016 to December 2019. A total of 60 patients under 12 years of age were included in this study were diagnosed as uni-lateral hydronephrosis for PUJ obstruction. Patients were divided into two groups by random lottery method and all patients underwent A-H pyeloplasty under general anaesthesia (G-A). In group-A, A-H pyeloplasty were done with using Double (D-J) stent and in group-B, 5Fr or 6Fr BMI tube were used as trans-anastomotic drainage. Patients were followed up after 2 weeks of operation, at 3 months and them at 6 months. The variables of the post-operative follow up study were patency of anastomosis, urinary tract infection, (UTI), urinary leakage and post-operative hospital stay and statistical analysis were done.Results:In group-A (30 cases), Anderson-Hynes pyeloplasty were done using D-J stent and in group-B (30 cases) with using trans-anastomotic BMI tube. In group-A most (73.33%) patients were below 5 years and in group-B 48 patients (80%) were below 5 years. In group-A mean age was 3.57+ 3.11 years and in group-B mean age was 3.31+3.21 years. There is no statistically significant difference in age distribution. In group-A left kidney were involved 66.7% cases and in group B in 80% cases left kidney were involved. In the early post-operative period, no urinary obstruction in group-A, however in 20% cases developed urinary obstruction in group-B but that was not statistically significant. In group-B continuous urinary leakage through drain tube was for 0-15 days but in group-B leakage was only or 0-1 day. It was statistically significant (p=0.037). In group-A, range of time of removal of drain tube was 4 days but in group-B range was 8-27 days. It was statistically significant (p=0.0001). Hospital stay in group-A was 4-8 days and in group B 9-29 days. It was also statistically significant (p=0.0001).Conclusion: In A-H pyeloplasty, morbidity of the patients can be reduced by using D-J stent which is more effective and safer. We found definite statistically significant difference in terms of urinary leakage, post-operative UTI, and hospital stay.