Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Urology. 2012 Dec;80(6):1357-60. doi: 10.1016/j.urology.2012.07.057. Epub 2012 Oct 23.
To evaluate the functional and morphologic outcome after open pyeloplasty for ureteropelvic junction obstruction (UPJO) in ectopic pelvic kidneys.
A retrospective review of all patients who underwent open pyeloplasty in ectopic pelvic kidneys was conducted. Records were evaluated with respect to age at presentation, preoperative imaging, surgical details, and postoperative course. Patients were followed up regularly for functional and morphologic outcome. Success was defined as symptomatic relief and radiographic improvement of obstruction at the last follow-up.
Between 1995 and 2010, 680 patients with primary UPJO underwent open dismembered pyeloplasty at our center. Of these patients, 43 (6.3%) had UPJO in ectopic pelvic kidneys. No perioperative complications were encountered in the study group. Mean follow-up was 42 months (range, 18-90 months), and 5 patients were lost to follow-up. The overall success rate was 82.6%. Postoperative hydronephrosis was improved in 20 (52.6%), stable in 11 (29%), and worsened in 7 (18.4%). Postoperative renal function was improved in 12 (31.6%), stable in 19 (50%), and deteriorated in 7 (18.4%). Redo pyeloplasty was required in 4 patients and secondary nephrectomy in 3. Preoperative differential renal function and surgeon experience were statistically significant predictors of improvement in renal function after pyeloplasty.
Open pyeloplasty for UPJO in ectopic pelvic kidneys is feasible, but varying degrees of hydronephrosis and radiologic obstruction persist after pyeloplasty that could be attributed to anatomy-related pelvocaliectasis, and so regular follow-up is warranted in this subpopulation.
评估异位盆腔肾肾盂输尿管连接部梗阻（UPJO）开放肾盂成形术的功能和形态学结果。
对所有在异位盆腔肾中接受开放肾盂成形术的患者进行回顾性研究。记录患者的年龄、术前影像学检查、手术细节和术后过程。定期对患者进行随访，以评估其功能和形态学结果。最后一次随访时症状缓解和梗阻的影像学改善定义为成功。
1995 年至 2010 年期间，我们中心对 680 例原发性 UPJO 患者进行了开放离断肾盂成形术。其中 43 例（6.3%）患有异位盆腔肾 UPJO。研究组无围手术期并发症。平均随访时间为 42 个月（范围 18-90 个月），5 例患者失访。总体成功率为 82.6%。20 例（52.6%）患者术后肾积水改善，11 例（29%）稳定，7 例（18.4%）恶化。12 例（31.6%）患者术后肾功能改善，19 例（50%）稳定，7 例（18.4%）恶化。4 例患者需要再次行肾盂成形术，3 例患者需要进行二次肾切除术。术前分肾功能和手术医生经验是肾盂成形术后肾功能改善的统计学显著预测因素。
开放肾盂成形术治疗异位盆腔肾肾盂输尿管连接部梗阻是可行的，但肾盂成形术后仍存在不同程度的肾积水和影像学梗阻，这可能归因于与解剖相关的肾盂扩张，因此在这一亚组人群中需要定期随访。
