Ismail A, Elkholy A, Zaghmout O, Alkadhi A, Elnaggar O, Khairat A, Elhassanat H, Mosleh A, Hamad B, Elzomer J, Elkaabi A
Pediatric Surgery Department, Hamad Medical Corporation, Doha, Qatar.
J Pediatr Urol. 2006 Jun;2(3):163-8. doi: 10.1016/j.jpurol.2005.07.005. Epub 2005 Aug 26.
The management of antenatally diagnosed ureteropelvic junction obstruction (PUJO) is controversial. Here, we present our experience over a period of 13 years and discuss our management protocol.
We reviewed the files of 234 patients with antenatally diagnosed congenital hydronephrosis due to PUJO. Management was tailored to each patient, based on a combination of diethylenetetraminepentacetic acid renogram outcome, pelvic diameter, as well as the patient's symptoms.
Pyeloplasty was carried out early in 52 kidneys. Of the total, 182 patients were managed expectantly. Out of these, 45 underwent delayed pyeloplasty. The remaining 137 patients (189 units) were managed non-operatively. In patients who underwent early pyeloplasty, the mean split differential renal function was 37% before and 40.05% after surgery. In those with delayed intervention, the mean renal function was 37.8% before and 42.2% after surgery. In patients who did not have surgery, the mean differential renal function was 45.7% initially and 48.2% at the last accepted follow up. The overall operative success rate was 97.9%.
We believe that pyeloplasty is the proper treatment for babies with congenital PUJO and <40% split differential function and/or pelvic diameter >35 mm at the initial visit. In other patients a period of observation is warranted, and pyeloplasty should be carried out only if their kidney function deteriorates or the renogram curve does not show improvement. With the excellent results of pyeloplasty we believe that a safer approach is to operate on more kidneys rather than risk of losing valuable kidney function.
产前诊断的肾盂输尿管连接部梗阻（PUJO）的治疗存在争议。在此，我们介绍我们13年来的经验并讨论我们的治疗方案。
我们回顾了234例产前诊断为先天性肾盂积水因PUJO的患者档案。根据二乙三胺五乙酸肾图结果、肾盂直径以及患者症状的综合情况，为每位患者制定个性化治疗方案。
52个肾脏早期进行了肾盂成形术。总共182例患者进行了观察等待。其中，45例接受了延迟肾盂成形术。其余137例患者（189个单位）接受了非手术治疗。早期接受肾盂成形术的患者中，术前平均分肾功能为37%，术后为40.05%。延迟干预的患者中，术前平均肾功能为37.8%，术后为42.2%。未接受手术的患者中，初始平均分肾功能为45.7%，最后一次接受随访时为48.2%。总体手术成功率为97.9%。
我们认为肾盂成形术是初始就诊时先天性PUJO且分肾功能<40%和/或肾盂直径>35mm婴儿的合适治疗方法。对于其他患者，有必要进行一段时间的观察，只有在肾功能恶化或肾图曲线未显示改善时才应进行肾盂成形术。鉴于肾盂成形术的良好效果，我们认为更安全的方法是对更多肾脏进行手术，而不是冒着失去宝贵肾功能的风险。
