Bassiouny I E
Pediatric Surgery Unit, Ain Shams University, Cairo, Egypt.
J Urol. 1992 Aug;148(2 Pt 2):685-7. doi: 10.1016/s0022-5347(17)36693-4.
The potential recoverability of an obstructed kidney detected by maternal antenatal ultrasound cannot be predicted by the currently available methods of investigation. Early repair in the presence of little parenchymal tissue may result in marked improvement in renal function. During the last 2 years 8 male and 2 female neonates with antenatal presentation of hydronephrosis were referred for postnatal evaluation. All patients had palpable renal masses clinically, which were unilateral (left side) in 9 and bilateral in 1. Blood urea nitrogen and creatinine were normal in all patients. Postnatal imaging included abdominal ultrasonography, voiding cystourethrography, excretory urography and quantitative functional evaluation with diuretic diethylenetriaminepentaacetic acid renal scan. Nonvisualization of a left hydronephrotic kidney was detected in all cases. Antegrade pyelography at surgical exploration (at age less than 2 months) was done to outline the anatomy. Stretched thinned out renal parenchymal tissue over a hugely distended renal pelvis was present and dismembered reduction pyeloureteroplasty was performed. A nephrostomy tube and ureteral stent were used. Followup ranged between 6 and 24 months. Remarkable recovery of renal function, more than 100% on renal scintigraphy, was noted postoperatively in all patients.
目前可用的检查方法无法预测通过产妇产前超声检测出的梗阻性肾脏的潜在恢复能力。在肾实质组织较少的情况下早期修复可能会使肾功能显著改善。在过去两年中，8名男性和2名女性新生儿因产前出现肾积水而被转诊进行产后评估。所有患者临床上均可触及肾脏肿块，其中9例为单侧（左侧），1例为双侧。所有患者的血尿素氮和肌酐均正常。产后影像学检查包括腹部超声、排尿性膀胱尿道造影、排泄性尿路造影以及用利尿二乙三胺五乙酸肾扫描进行定量功能评估。所有病例均检测到左侧肾积水肾脏不显影。在手术探查时（年龄小于2个月）进行顺行肾盂造影以勾勒解剖结构。在极度扩张的肾盂上可见拉伸变薄的肾实质组织，并进行了离断性肾盂输尿管成形术。使用了肾造瘘管和输尿管支架。随访时间为6至24个月。所有患者术后肾功能均有显著恢复，肾闪烁显像显示恢复超过100%。
