Koff S A
Ohio State University College of Medicine, Columbus.
Urol Clin North Am. 1990 May;17(2):263-72.
The preceding discussion has identified many of the frustrating difficulties in the definition, diagnosis, and determination of the significance of obstruction in hydronephrosis. Unfortunately, doubts have been raised about the indications for surgical intervention, which is so often needed to prevent renal deterioration. Are the newer diagnostic tests seriously flawed; should we be relying more heavily on anatomic studies such as intravenous and retrograde pyelography and operating purely for pelvic enlargement and characteristic radiographic appearances? Absolutely not. All upper urinary tract (ureteropelvic) obstructions are not the same. Obstruction is not a single disease process, and its outcome cannot be predicted purely by anatomic appearance. Most cases of suspected obstruction are straightforward, and the correct diagnosis can be arrived at easily, but the difficult cases remain a diagnostic challenge. In these, we must use newer diagnostic tests freely but not merely as triggers for surgical intervention; they are not that accurate. Instead, they should be used to obtain as much physiologic information as possible to help categorize the suspected obstruction and predict its potential for obstructive injury. Only in this way can we hope to prevent progressive renal deterioration and to ensure that surgical reconstruction is both necessary and effective.
前面的讨论已经指出了肾积水梗阻在定义、诊断以及判定其重要性方面存在的许多令人沮丧的困难。不幸的是，对于手术干预的指征也产生了疑问，而手术干预常常是预防肾脏损害所必需的。新的诊断测试是否存在严重缺陷？我们是否应该更依赖于诸如静脉肾盂造影和逆行肾盂造影等解剖学检查，并仅仅因为肾盂扩大和典型的影像学表现而进行手术？绝对不是。所有上尿路（输尿管肾盂）梗阻并非相同。梗阻不是单一的疾病过程，其结果不能仅仅通过解剖学外观来预测。大多数疑似梗阻的病例很简单，能够轻松做出正确诊断，但困难的病例仍然是一个诊断挑战。在这些病例中，我们必须自由地使用新的诊断测试，但不仅仅是将其作为手术干预的触发因素；它们并没有那么准确。相反，应该用它们来获取尽可能多的生理学信息，以帮助对疑似梗阻进行分类，并预测其造成梗阻性损伤的可能性。只有这样，我们才有希望防止肾脏进行性损害，并确保手术重建既有必要又有效。
