Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2015 Apr;193(4):1278-82. doi: 10.1016/j.juro.2014.10.100. Epub 2014 Oct 30.
Equivocal ureteropelvic junction obstruction refers to clinical symptoms and/or other radiological suggestions of possible ureteropelvic junction obstruction but with inconclusive results of obstruction on diuretic renogram. We evaluated long-term outcomes in patients with equivocal ureteropelvic junction obstruction treated with minimally invasive pyeloplasty.
We retrospectively analyzed the records of 125 consecutive patients who underwent minimally invasive pyeloplasty as performed by a single surgeon from May 2004 to July 2013. Of 98 patients with followup those with more than 6-month followup were included in analysis. Equivocal ureteropelvic junction obstruction, defined as half-life less than 20 minutes on diuretic renogram, was identified in 23 patients. All patients underwent transperitoneal minimally invasive pyeloplasty. We evaluated patient demographics, preoperative and postoperative symptoms and renal function.
The 16 female and 7 male patients with equivocal ureteropelvic junction obstruction had flank pain and associated hydronephrosis on imaging. At a median followup of 20.2 months (range 7 to 75) 95.7% of patients with equivocal obstruction achieved complete symptom resolution. Mean ± SD preoperative and postoperative half-life was 14.1 ± 3.7 and 7.4 ± 4.2 minutes, respectively, for an improvement of 6.7 minutes (p < 0.001). In 1 patient (4.3%) with equivocal obstruction of a complicated iatrogenic etiology treatment ultimately failed postoperatively and endopyelotomy was required. There was no statistically significant difference in clinical or radiological success between the equivocal obstruction group and the 75 patients treated with minimally invasive pyeloplasty for definitive ureteropelvic junction obstruction (p = 0.44 and 0.07, respectively).
In patients with radiographic equivocal ureteropelvic junction obstruction and flank pain minimally invasive pyeloplasty efficaciously provides symptomatic relief and functional preservation. Results are comparable to those in patients with high grade obstruction.
输尿管肾盂连接部梗阻的诊断存在争议是指临床症状和/或其他影像学提示可能存在输尿管肾盂连接部梗阻，但利尿肾动态显像检查结果不能确定梗阻。我们评估了对诊断存在争议的输尿管肾盂连接部梗阻患者采用微创肾盂成形术治疗的长期疗效。
我们回顾性分析了 2004 年 5 月至 2013 年 7 月期间由同一位外科医生进行的微创肾盂成形术的 125 例连续患者的记录。98 例有随访的患者中，有 6 个月以上随访的患者纳入分析。利尿肾动态显像检查半排时间<20 分钟的患者被定义为诊断存在争议的输尿管肾盂连接部梗阻患者，共 23 例。所有患者均行经腹腔微创肾盂成形术。我们评估了患者的人口统计学资料、术前和术后症状以及肾功能。
23 例诊断存在争议的输尿管肾盂连接部梗阻患者为女性 16 例，男性 7 例，均有腰痛和影像学相关的肾积水。在中位随访时间为 20.2 个月（范围 7 至 75）时，95.7%的诊断存在争议的梗阻患者完全缓解症状。平均术前和术后半排时间分别为 14.1 ± 3.7 和 7.4 ± 4.2 分钟，改善了 6.7 分钟（p < 0.001）。1 例（4.3%）诊断存在争议的梗阻患者病因复杂，为医源性输尿管损伤，术后治疗失败，需要行经皮肾镜肾盂切开术。诊断存在争议的梗阻组与 75 例因明确的输尿管肾盂连接部梗阻行微创肾盂成形术治疗的患者在临床或影像学成功率方面无统计学差异（分别为 p = 0.44 和 0.07）。
对于有影像学诊断存在争议的输尿管肾盂连接部梗阻和腰痛的患者，微创肾盂成形术可有效缓解症状并保留肾功能。疗效与高分级梗阻患者相似。
