Gupta D K, Chandrasekharam V V, Srinivas M, Bajpai M
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Urology. 2001 Mar;57(3):547-50. doi: 10.1016/s0090-4295(00)01046-3.
To evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with kidneys with ureteropelvic junction obstruction (UPJO) and split renal function (SRF) of less than 10%, because the management of such cases is still under debate. If SRF improves, we perform pyeloplasty, otherwise nephrectomy is done.
The records of all patients with UPJO (n = 20; 17 unilateral and 3 solitary kidney) with poor function who underwent PCN were analyzed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose oral trimethoprim prophylaxis. Repeated renography was obtained after 4 weeks. If no improvement in the SRF had occurred, nephrectomy was performed, otherwise pyeloplasty was performed. The patients were followed up with renograms at 3 months, 1 year, 2 years, and 5 years.
Twelve of 17 kidneys with unilateral UPJO improved after PCN drainage and underwent pyeloplasty. The 5 kidneys that did not show improvement in the SRF underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF increased to 29.2% +/- 12.6% and pyeloplasty was performed. At a mean follow-up of 2.3 years, none of these patients had developed hypertension, and the most recent SRF value was 31.4% +/- 12.8%.
Most of the poorly functioning UPJO kidneys show improvement in function and not all such kidneys should be removed without a trial of PCN.
评估对所有肾盂输尿管连接部梗阻（UPJO）且分肾功能（SRF）低于10%的患者进行经皮肾造瘘术（PCN）的结果，因为此类病例的治疗仍存在争议。如果SRF改善，我们进行肾盂成形术，否则进行肾切除术。
分析所有因功能不良而接受PCN的UPJO患者（n = 20；17例单侧，3例孤立肾）的记录。PCN留置原位至少4周，在此期间患者接受低剂量口服甲氧苄啶预防。4周后重复进行肾图检查。如果SRF没有改善，则进行肾切除术，否则进行肾盂成形术。在3个月、1年、2年和5年时对患者进行肾图随访。
17例单侧UPJO患者中有12例在PCN引流后功能改善并接受了肾盂成形术。5例SRF未改善的患者接受了肾切除术。在PCN引流后功能改善的单侧UPJO患者中，SRF升至29.2%±12.6%并进行了肾盂成形术。平均随访2.3年，这些患者均未发生高血压，最近的SRF值为31.4%±12.8%。
大多数功能不良的UPJO肾脏功能会改善，并非所有此类肾脏都应在未经PCN试验的情况下被切除。
