Surgical decision of concomitant ureteropelvic junction obstruction with congenital abnormalities of the kidney / 中华泌尿外科杂志

Objective To investigate the timing and scheme of surgical treatment for the concomitant ureteropelvic junction obstruction(UPJO) and congenital abnormalities of the kidney.Methods The clinical data of 155 patients with concomitant UPJO and congenital abnormalities of the kidney from January 2006 to January 2016 was retrospectively analyzed.There were 107 males and 48 females,who aged 6 months to 16 years and 6 months.The average time was 5 years and 9 months old when they received operation.There were 8 cases less than 1 year old.There were 93 cases of UPJO on the left side,54 cases on the right side,and 8 cases on both sides.There were 33 cases with duplication of kidney,19 cases with solitary kidney,and 6 cases with renal dysplasia,6 cases with renal ectopia,12 cases with polycystic kidney disease,and 41 cases with dysplasia;2 cases with renal malrotation.There were 100 cases with symptoms such as fever,abdominal pain,vomiting.5 cases had received Anderson-Hynes pyeloplasty in other hospitals,2 cases received nephrectomy with symptoms did not relieve.4 cases were treated with nephrostomy in other hospital.Children with the repeated clinical symptoms,or renal function decreased significantly,or hydronephrosis progressive to the anteroposterior diameter of more than 30 mm received surgical treatment.Results There were 140 cases received Anderson-Hynes pyeloplasty,and 8 cases received nephrectomy with 5 cases were UPJO side and 3 cases were only abnormalities of the kidney without UPJO.All patients received IVP or ultrasonography postoperative 3-6 months,which showed hydronephrosis improved or no obvious change,and 4 cases were improved obviously.The IVP results showed that 5 patients with renal dysplasia together with UPJO had the renal function improved.There were 128 cases followed up for 12 to 106 months,with an average of 64.5 months.All patients had no clinical symptoms.83 cases were reexamined by IVP or ultrasonography,and hydronephrosis was getting better or no change.Conclusions The patients with concomitant UPJO and congenital abnormalities of the kidney don't need surgery in advance.The best choice for those patients is Anderson-Hynes pyeloplasty.The indication of nephrectomy should be considered carefully.

Trends of treatment for posterior urethral valves / 中华实用儿科临床杂志

Posterior urethral valves(PUV) is the most common cause of lower tract obstruction in boys.With the understanding of the prognostic factors of PUV in depth,PUVs can have a profound effect on the function of bladder and upper urinary tract though valves are completely resected.The treatments of PUV include prenatal intervention,the antenatal vesicoamniotic shunt and fetal cystoscopy can be considered in selected patients with oligohydramnios.But the role of antenatal intervention is unclear.The gold standard for postnatal treatment of PUV is valve ablation.Vesicostomy is reserved primarily for the children with PUV whose urethra cannot accommodate an endoscope, as well as have severe urinary tract infections.Circumcision should be encouraged as a prophylactic measure for children with PUV who should have high rate of urinary tract infection.Vesicoureteral reflux is very common in PUV patients, and life-long monitoring of these patients is mandatory, as bladder dysfunction and valve bladder may be found during follow-up.These factors contribute toward the devolution of a bladder into dysfunction status are high voiding pressures and increased residual urine.Medication and clean intermittent catheterization are two main interventions, for the children who difficult to treat, an appendicovesicostomy utilizing the Mitrofanoff principle presents an useful option.Renal transplantation is an alternative for patients with PUV who progress to end-stage renal disease.Bladder dysfunction plays an important role in the development of PUV and urodynamic examination can be used to assess the function of the bladder to achieve timely and effective intervention.

Policy barriers and strategies of the two-way referral system / 中华医院管理杂志

The two-way referral system is an inevitable step in the health reform,as it could effectively channel patients,promote rational use of healthcare resources,and improve the quality of care at primary medical institutions.Only by means of resources integration for improvement of existing policies,and building a healthcare system comprising partnering medical institutions of all levels with proper division of responsibilities,can the two-way system come into practice smoothly.This will alleviate the difficulty in seeing doctors and expensiveness of treatment.