Rodríguez Vela L, Rioja Sanz C, González Enguita C, Gil Sanz M J, Allepuz Losa C, Martínez Bengoechea J, Liedana Torres J M, Rioja Sanz L A
Arch Esp Urol. 1989 Sep;42(7):629-46.
The ureteropelvic junction (UPJ) is the most common site of upper urinary tract obstruction. We report on 46 adult patients (50 renal units) that had been treated for a UPJ anomaly at our department over a 10-year period. The most common clinical manifestations observed were lumbar pain and/or colic (82.6%) and infection (34.8%). Genitourinary malformations were observed in 21.8% of the patients. The following treatment modalities were performed: 8 nephrectomies, 39 repair surgery procedures, 3 renal units with mild dilatation and no obstruction did not undergo surgery and were closely followed. The Anderson-Hynes pyeloplasty procedure was performed in 37 (95%) renal units and the Foley Y-V plasty in 2 (5%). The most important complications were anastomotic stricture (4) and urinary fistula (2). Overall, the results of repair surgery were good in 69.2%, fair in 20.5% and poor in 10.3% of the cases. Better results were achieved in those cases with moderate (86% good results) than in those with severe (47% good results) dilatation. Following pyeloplasty, 95% of the patients were pain-free, 1 (2.3%) patient had episodes of symptomatic infection and deterioration of renal function was observed in only 1 patient with a single kidney and severe chronic renal failure prior to surgery. At 2 years, dilatation had improved in 64%, remained unchanged in 31%, and became worse in 5%. In the management of pyelocaliceal dilatation, we believe it is fundamental to clearly establish the presence of obstruction and predict the functional recovery of the obstructed kidney. Our diagnostic and therapeutic approach is described. For upper urinary tract dilatation, the following is performed: simple or diuresis IVP, diuresis renography, ultrasonography and CUMS (if reflux is suspected). When doubts exist or when the results are unclear, pressure flow urodynamic studies are performed. Thus, we perform repair surgery in dilatations with functional obstruction to avoid progressive renal deterioration. The literature on the diagnostic techniques for the assessment of obstruction and functional recovery is reviewed.
肾盂输尿管连接处（UPJ）是上尿路梗阻最常见的部位。我们报告了在10年期间于我科接受UPJ异常治疗的46例成年患者（50个肾单位）。观察到的最常见临床表现为腰痛和/或绞痛（82.6%）以及感染（34.8%）。21.8%的患者存在泌尿生殖系统畸形。采用了以下治疗方式：8例肾切除术，39例修复手术，3个轻度扩张且无梗阻的肾单位未接受手术，而是密切随访。37个（95%）肾单位采用了安德森 - 海因斯肾盂成形术，2个（5%）肾单位采用了弗利Y - V成形术。最重要的并发症是吻合口狭窄（4例）和尿瘘（2例）。总体而言，修复手术结果良好的占69.2%，一般的占20.5%，差的占10.3%。中度扩张的病例（86%结果良好）比重度扩张的病例（47%结果良好）取得了更好的效果。肾盂成形术后，95%的患者疼痛消失，1例（2.3%）患者有症状性感染发作，仅1例术前患有单肾且严重慢性肾衰竭的患者出现肾功能恶化。2年后，64%的患者扩张情况有所改善，31%的患者保持不变，5%的患者情况恶化。在肾盂肾盏扩张的处理中，我们认为明确梗阻的存在并预测梗阻肾的功能恢复至关重要。描述了我们的诊断和治疗方法。对于上尿路扩张，进行以下检查：简单或利尿静脉肾盂造影、利尿肾图、超声检查和排尿性膀胱尿道造影（如果怀疑有反流）。当存在疑问或结果不明确时，进行压力流尿动力学研究。因此，对于存在功能性梗阻的扩张情况，我们进行修复手术以避免肾功能进行性恶化。综述了关于评估梗阻和功能恢复的诊断技术的文献。
