ABSTRACT
Background: Uretero-Pelvic Junction Obstruction (UPJO) is an important cause of hydronephrosis in pediatric age group. The choice of treatment could be conservative or surgical. Commonly Anderson-Hynes pyeloplasty is practiced with internal, external or partly internal partly external stent.Methods: This was a prospective study of 40 patients with UPJO, divided into 2 groups consecutively, each consisting of 20 patients. All patients underwent open Anderson-Hynes pyeloplasty. Cummings stent were given in one group for drainage and conventional DJ stent were used for another group.Results: The mean hospital stay was lesser in DJ stent group (8.4±2.13) compared to Cummings stent group (11.4±0.68), not only in respect to primary admission, but also including readmission for cystoscopic stent removal. The incidence of complications was also fewer in Cumming stent group. Stent migration and urinary tract infection (UTI) were more associated with DJ stent (2 each) than Cumming stent (0 each). However, dysuria was more in case of cumming stent (2 patients) than DJ stent (1 patient).Conclusions: The mean hospital stay in DJ stent insertion is less even if duration for cystoscopic removal is considered. The complication of stent removal and UTI are more with DJ stent though dysuria is more in case of Cummings stent.
ABSTRACT
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.
ABSTRACT
The operative technic for the correction of hydronephrosis due to obstruction at ureteropelvic junction has been discussed. There are two different types of technics in pyeloplasty ; 1st. nondismembered pyeloplasty molds and restructures the obstructed ureteropelvic junction without completely dismembering it and 2nd. dismembered pyeloplasty interrupts the continuity of the transport system of the obstructed ureteropelvic junction. Since Andereon-Hynes reported the technics which belongs to dismembered pyeloplasty for retrocaval ureter in 1949, many articles with satisfactory result have been published. We report Anderson-Hynes pyeloplasty for hydronephrosis secondary to obstruction of the ureteropelvic Junction in 7 cases. Advantages of Anderson-Hynes pyeloplasty are as follows. 1. Complete excision of the obstructive segment. 2. Reduction of the dead space. 3. Excision of a good part of the sick pelvis. 4. Activation of latent pacemaker P cells.