Castagnetti Marco, Novara Giacomo, Beniamin Francesco, Vezzú Beatrice, Rigamonti Waifro, Artibani Walter
Section of Paediatric Urology, Urology Unit, University Hospital of Padova, Padova, Italy.
BJU Int. 2008 Sep;102(7):862-8. doi: 10.1111/j.1464-410X.2008.07597.x. Epub 2008 Mar 11.
To systematically review previous reports and thus determine the functional outcome after pyeloplasty in children with unilateral hydronephrosis due to pelvi-ureteric junction obstruction, and the possible variables that could affect it.
We searched Medline/PubMed, Embase, and Web of Science for articles in English published from 1966 to 2007, using both 'medical subject headings' and 'free text' protocols. Abstracts, full texts, and bibliographies of pertinent papers were reviewed to select studies of scintigraphic renal function before and after pyeloplasty. The postoperative change in scintigraphic renal function was assessed in relation to presentation (antenatal vs postnatal), timing of surgery (early vs delayed), age at surgery, and preoperative ultrasonography (US) and scintigraphic findings.
Thirty-six studies (2.1% of the initial search) were eventually selected for review. Studies were generally of poor scientific quality and very heterogeneous in their indications for surgery and follow-up protocols. Postoperative function showed a wide variability. Symptomatic patients diagnosed postnatally seemed to have a greater chance of functional improvement after surgery than asymptomatic patients diagnosed antenatally. The chance of improvement seemed also to be greater in patients with moderately rather than severely impaired preoperative function. Otherwise, the improvement seemed unrelated to the age at surgery, the preoperative US findings, or the excretion pattern on renal scintigraphy. Of patients having delayed surgery >97.5% had preserved function afterward. CONCLUSIONS; Patients with moderately impaired preoperative function and those diagnosed postnatally because of symptoms are those with the greatest likelihood of having a functional improvement after surgery.
系统回顾既往报告，从而确定因肾盂输尿管连接处梗阻导致单侧肾积水的儿童肾盂成形术后的功能结局，以及可能影响该结局的变量。
我们检索了1966年至2007年期间发表在Medline/PubMed、Embase和Web of Science上的英文文章，同时使用“医学主题词”和“自由文本”检索方案。对相关论文的摘要、全文和参考文献进行了审查，以选择肾盂成形术前和术后肾闪烁造影肾功能的研究。根据临床表现（产前与产后）、手术时机（早期与延迟）、手术年龄以及术前超声（US）和闪烁造影结果，评估术后肾闪烁造影肾功能的变化。
最终选择了36项研究（占初始检索的2.1%）进行综述。这些研究的科学质量普遍较差，在手术指征和随访方案方面差异很大。术后功能表现出很大的变异性。产后诊断出的有症状患者术后功能改善的机会似乎比产前诊断出的无症状患者更大。术前功能中度受损而非严重受损的患者改善的机会似乎也更大。否则，改善似乎与手术年龄、术前超声检查结果或肾闪烁造影的排泄模式无关。延迟手术超过97.5%的患者术后功能得以保留。结论：术前功能中度受损且因症状在产后被诊断出的患者术后功能改善的可能性最大。
