Chertin B, Fridmans A, Knizhnik M, Hadas-Halperin I, Hain D, Farkas A
Department of Urology, Diagnostic Radiology and Nuclear Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
J Urol. 1999 Sep;162(3 Pt 2):1037-40. doi: 10.1016/S0022-5347(01)68058-3.
Prenatal ultrasound leads to the early detection of hydronephrosis. When followed by the early diagnosis of ureteropelvic junction obstruction surgical treatment, if indicated, is associated with minimal morbidity. We attempt to prove the benefits of this therapeutical approach from the point of view of renal function.
From 1979 to 1997, 452 patients with ureteropelvic junction obstruction underwent dismembered pyeloplasty. Of these patients 113 with comparable data were retrospectively evaluated. Patients were divided into group 1-50 who presented with prenatal hydronephrosis and group 2-63 with neonatal hydronephrosis who were lost to followup and who then presented with symptoms leading to the diagnosis of ureteropelvic junction obstruction. In each group the diagnostic criteria and indications for surgery were identical based on symptomatology, ultrasound and renal scan. Patients with bilateral disease, solitary kidney or vesicoureteral reflux were excluded from study. In groups 1 and 2 median patient age at surgery was 11 months and 5 years, and average postoperative followup was 4.2 and 3.2 years, respectively.
In 41 of the 50 group 1 and 60 of the 63 group 2 patients hydronephrosis was severe and the renal pelvis was more than 3 cm. wide. Poor relative renal function (less than 30%) was significantly more pronounced in group 2 than in group 1 (56 of 63 patients or 89% versus 6 of 50 or 12%, p <0.05). In all 113 patients postoperative followup ultrasound and renal scan revealed significant improvement in hydronephrosis and washout curve pattern. There was a significant difference in the 2 groups in regard to renal function improvement postoperatively (66% of group 1 versus 16% of group 2 patients, p <0.05).
We believe that patients who undergo prenatal imaging and are diagnosed early with ureteropelvic junction obstruction should be carefully and meticulously followed. Special efforts should be made to ensure that patients are not lost to followup. After any sign of deterioration develops early surgery is indicated. According to our data operative treatment results in improved renal function.
产前超声检查可早期发现肾积水。若随后能早期诊断出肾盂输尿管连接部梗阻，并在必要时进行手术治疗，其发病率会降至最低。我们试图从肾功能的角度来证明这种治疗方法的益处。
1979年至1997年间，452例肾盂输尿管连接部梗阻患者接受了离断性肾盂成形术。对其中113例具有可比数据的患者进行回顾性评估。患者被分为两组：第1组50例，产前即出现肾积水；第2组63例，新生儿期出现肾积水，失访后因出现症状而被诊断为肾盂输尿管连接部梗阻。每组中，基于症状、超声和肾扫描的手术诊断标准和指征均相同。双侧病变、单肾或膀胱输尿管反流患者被排除在研究之外。第1组和第2组患者手术时的中位年龄分别为11个月和5岁，术后平均随访时间分别为4.2年和3.2年。
第1组50例患者中的41例以及第2组63例患者中的60例肾积水严重，肾盂宽度超过3厘米。第2组中相对肾功能较差（低于30%）的情况明显比第1组更为显著（63例患者中的56例，即89%，对比50例中的6例，即12%，p<0.05）。在所有113例患者中，术后随访超声和肾扫描显示肾积水及洗脱曲线模式有显著改善。两组术后肾功能改善情况存在显著差异（第1组患者的66%对比第2组患者中的16%，p<0.05）。
我们认为，接受产前影像学检查并早期诊断为肾盂输尿管连接部梗阻的患者应得到仔细且精心的随访。应特别努力确保患者不失访。一旦出现任何恶化迹象，应尽早进行手术。根据我们的数据，手术治疗可改善肾功能。
