The clinical charactaristics analysis of the acute symptomatic ureteropelvic junction obstruction in children / 中华泌尿外科杂志

ABSTRACT

Objective To analyze the clinical charactaristics of acute symptomatic the ureteropelvic junction obstruction (UPJO) in children,who present abdominal pain as the primary symptom.Methods Retrospective analysis was performed in children of UPJO,who claimed abdominal pain as the primary symptom in our hospital from January 2009 to December 2016.Totally 48 cases were included.40 boys,8 girls.38 cases were dignosed as left UPJO,the others were right.The mean age was 7.2y (range 2.0-15.6y).Most patients are school age children.Renal ultrasonography was repeated to record the changes from the symptomatic to the asymptomatic stage.Diuretic renogram examination (ECT) was used to confirm UPJO and assess DRF(differential renal function)in all patients.Results 30 cases (62.5％) presented sole abdominal pain,while the other 18 cases (37.5％) had combined symptoms,such as nausea and vomiting,and hematuria.9 cases (20.5％) had abdominal pain only once,while the other 39 (79.5％) cases had recurrent abdominal pain.All cases showed significant differences in renal pelvis dilation and renal parenchyma thickness between the period of occurrence of abdominal pain[(35.5 ± 17.1) mm,(7.2 ± 4.9) mm] and normal condition [(23.4 ± 18.4) mm,(8.9-± 5.6) mm] (P ＜ 0.05).All patients underwent preoperative ECT,and DRF were ≥40％ in 31 cases (64.6％) and ＜40％ in 17 cases (35.4％).48 cases underwent unilateral dismembered pyeloplasty.48 cases underwent unilateral dismembered pyeloplasty.During the operation,sole ureteropelvic junction stenosis were diagnosed in 28 cases,aberrant vascular compression in 9 cases,polyps in 6 cases,high ureteral insertion in 2 cases,and multi-factors in 3 cases.The average DRF caused by aberrant vascular compression or polyps was ＞ 40％.All patients were followed up for 45.6 months,no abdominal pain was ever reported.Conclusions Acute symptomatic UPJO in children is more common in school-age children.The abdominal pain is intermittent,recurrent.It may happen with other symptoms.There is a significant increase in renal pelvis dilation and a decrease in renal parenchyma thickness on ultrasonography when the abdominal pain occures.US performed during the onset of abdominal pain and non-abdominal pain is an important method for the diagnosis of acute symptomatic UPJO in children.