Egan S C, Stock J A, Hanna M K
Section of Urology, Department of' Surgery, University of Medicine and Dentistry of New Jersey, USA.
Tech Urol. 2001 Dec;7(4):276-80.
Renal ultrasound changes after pediatric pyeloplasty were reported recently in the literature, mainly on unstented pyeloplasties. We evaluated the time to improvement or resolution of hydronephrosis in pediatric patients who underwent double-J stented pyeloplasty for ureteropelvic junction (UPJ) obstruction and compared our results to unstented pyeloplasties.
Ultrasonic grading of hydronephrosis after double-J stented pyeloplasty was performed according to the Society for Fetal Urology criteria at intervals of 0 to 3. 3 to 6, 6 to 12, and greater than 12 months postoperatively. Twenty-six pyeloplasties met all criteria for inclusion. The median patient age was 4 months.
Of the 26 pyeloplasties studied, 18 kidneys had grade 4, 7 grade 3, and I grade 2 hydronephrosis. Twenty-two percent of kidneys with grade 4 hydronephrosis had resolution of pyelocaliectasis at the 0- to 3-month ultrasound examination; all of these kidneys had the stents removed prior to being studied. No patient with improvement of hydronephrosis worsened on subsequent examinations. All but three patients improved over 1-year follow-up: 11 (42%) to grade 0, 5 (19.2%) to grade 1, 6 (23%) to grade 2, and 1 (3.8%) to grade 3. The average final grade was 1.56 for grade 4 and 0.57 for grade 3 hydronephrosis. This represented more rapid improvement than unstented pyeloplasties. Average indwelling time for double-J stent was 52 days.
Improvement and sometimes resolution of hydronephrosis after internal double-J stented pyeloplasty for UPJ obstruction is rapid and can occur within the first 3 months postoperatively. One year postoperatively, the majority of renal units have grade 2 hydronephrosis or less. We recommend the use of indwelling double-J ureteral stents in all pediatric patients undergoing dismembered pyeloplasty for UPJ obstruction to allow for more rapid improvement and possible resolution ofpyelocaliectasis. Further comparison of stented vs. unstented pyeloplasty is needed.
近期文献报道了小儿肾盂成形术后的肾脏超声变化，主要针对无支架肾盂成形术。我们评估了因输尿管肾盂连接部（UPJ）梗阻接受双J管支架肾盂成形术的小儿患者肾积水改善或消退的时间，并将我们的结果与无支架肾盂成形术进行比较。
根据胎儿泌尿外科学会标准，在术后0至3个月、3至6个月、6至12个月以及大于12个月的时间间隔，对双J管支架肾盂成形术后的肾积水进行超声分级。26例肾盂成形术符合所有纳入标准。患者中位年龄为4个月。
在研究的26例肾盂成形术中，18个肾脏为4级肾积水，7个为3级，1个为2级。4级肾积水的肾脏中，22%在术后0至3个月的超声检查时肾盂扩张得到缓解；所有这些肾脏在检查前已取出支架。肾积水改善的患者在后续检查中均未恶化。除3例患者外，所有患者在1年随访中均有改善：11例（42%）改善至0级，5例（19.2%）改善至1级，6例（23%）改善至2级，1例（3.8%）改善至3级。4级肾积水的平均最终分级为1.56，3级肾积水为0.57。这表明比无支架肾盂成形术改善更快。双J管的平均留置时间为52天。
对于UPJ梗阻，行内置双J管支架肾盂成形术后肾积水改善，有时甚至消退迅速，可在术后前3个月内出现。术后1年，大多数肾单位的肾积水为2级或更低。我们建议对所有因UPJ梗阻接受离断性肾盂成形术的小儿患者使用双J管输尿管留置支架，以实现更快的改善并可能缓解肾盂扩张。需要对有支架与无支架肾盂成形术进行进一步比较。
