Capolicchio G, Leonard M P, Wong C, Jednak R, Brzezinski A, Salle J L
Division of Pediatric Urology, Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada.
J Urol. 1999 Sep;162(3 Pt 2):1029-32. doi: 10.1016/S0022-5347(01)68055-8.
We reviewed our experience with corrective surgery for congenital ureteropelvic junction obstruction to assess the impact of mode of presentation on renal function at diagnosis and on postoperative recovery of function.
We reviewed the records of consecutive children who underwent pyeloplasty or nephrectomy for ureteropelvic junction obstruction during a 5-year period at our hospitals. Patients were divided into those with and without a prenatal diagnosis of hydronephrosis. In each group we compared preoperative and postoperative differential renal function, as measured by nuclear renography.
We identified 89 patients, of whom 51 (57%) and 38 (43%) presented with prenatal and postnatal hydronephrosis, respectively. Kidneys in which hydronephrosis was diagnosed prenatally had better average differential renal function than those in which the condition was detected postnatally (45 versus 37%). This difference was even more significant in kidneys with less than 40% initial function (31 versus 21%). Presentation with a palpable mass was associated with worst renal function (mean 23%). Postoperatively renal function did not recover significantly in either group. There was a minimal increase in postoperative differential renal function in the subgroup of patients in whom initial differential renal function was less than 40%, although there was no significant difference in the 2 groups (6.5 versus 4.8%).
The early diagnosis of hydronephrosis provided by prenatal ultrasonography is associated with less obstructive nephropathy. Prolonged followup is necessary for studies of the natural history of hydronephrosis because relevant obstruction manifests clinically years later. Despite successful pyeloplasty function recovery is minimal in kidneys with poor function and hydronephrosis diagnosed prenatally. Our findings do not support previous observations that poor function markedly improves after obstruction is relieved.
我们回顾了先天性输尿管肾盂连接部梗阻矫正手术的经验，以评估发病方式对诊断时肾功能及术后功能恢复的影响。
我们回顾了我院5年间因输尿管肾盂连接部梗阻接受肾盂成形术或肾切除术的连续儿童病例记录。患者分为产前诊断为肾积水和未产前诊断为肾积水两组。在每组中，我们比较了术前和术后通过核素肾图测量的分肾功能。
我们共确定了89例患者，其中51例（57%）和38例（43%）分别表现为产前和产后肾积水。产前诊断为肾积水的肾脏平均分肾功能优于产后诊断的肾脏（45%对37%）。在初始功能低于40%的肾脏中，这种差异更为显著（31%对21%）。可触及肿块的患者肾功能最差（平均23%）。两组术后肾功能均未显著恢复。初始分肾功能低于40%的亚组患者术后分肾功能略有增加，尽管两组间无显著差异（6.5%对4.8%）。
产前超声检查提供的肾积水早期诊断与梗阻性肾病较轻相关。由于相关梗阻在数年后才会临床显现，因此对肾积水自然病史的研究需要长期随访。尽管肾盂成形术成功，但产前诊断为肾积水且功能较差的肾脏功能恢复甚微。我们的研究结果不支持先前的观察结果，即梗阻解除后功能不良会明显改善。
