Bansal Utsav K, Dangle Pankaj P, Stephany Heidi, Durrani Asad, Cannon Glenn, Schneck Francis X, Ost Michael C
Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Front Pediatr. 2017 Jun 1;5:126. doi: 10.3389/fped.2017.00126. eCollection 2017.
To assess the optimal length of follow-up for patients undergoing both open and minimally invasive pyeloplasties to ensure prompt detection of a recurrent obstruction. There are no standard guidelines on ideal follow-up and imaging post-pediatric pyeloplasty currently.
A retrospective chart review identified 264 patients (<18 years old) who underwent pyeloplasty for ureteropelvic junction obstruction between April 2002 and December 2014. Ultrasound was obtained every 3-4 months for the first year following pyeloplasty and thereafter at discretion of treating physician. Patient characteristics including symptoms and imaging were reviewed.
Of the 264 patients, 72% were male with mean age of 51 months and follow-up of 26.8 months. Approximately 73% followed up to 3 years. Fourteen patients (5.3%) had a recurrent obstruction. Among the failures, 85% were diagnosed and underwent successful redo pyeloplasty within 3 years. Six infants had a recurrence (43% of all unsuccessful surgeries) and were diagnosed within 3 years of the initial surgery. Patients undergoing a minimally invasive procedure were less likely to be followed for more than 3 years compared to an open procedure ( < 0.001). Patients with severe hydronephrosis preoperatively were followed longer ( = 0.031). Age at surgery and type of surgical approach ( < 0.01) were significant predictors of length of follow-up in a negative binomial regression.
Based on the results, a minimum of 3 years of follow-up is necessary to detect the majority of recurrent obstructions. Those patients who have higher than average lengths of follow-up tend to be younger and/or underwent an open surgical approach.
评估接受开放手术和微创肾盂成形术的患者的最佳随访时长，以确保及时发现复发性梗阻。目前尚无关于小儿肾盂成形术后理想随访及影像学检查的标准指南。
一项回顾性图表审查确定了264例（<18岁）在2002年4月至2014年12月期间因肾盂输尿管连接部梗阻接受肾盂成形术的患者。肾盂成形术后第一年每3 - 4个月进行一次超声检查，此后由主治医生酌情安排检查。对患者特征包括症状和影像学检查进行了回顾。
264例患者中，72%为男性，平均年龄51个月，随访时间为26.8个月。约73%的患者随访至3年。14例患者（5.3%）出现复发性梗阻。在这些失败病例中，85%在3年内被诊断并成功接受了再次肾盂成形术。6例婴儿出现复发（占所有手术失败病例的43%），并在初次手术3年内被诊断出来。与开放手术相比，接受微创手术的患者随访超过3年的可能性较小（<0.001）。术前重度肾积水的患者随访时间更长（=0.031）。手术时年龄和手术方式类型（<0.01）在负二项回归中是随访时长的显著预测因素。
基于这些结果，至少需要3年的随访才能发现大多数复发性梗阻。那些随访时间高于平均水平的患者往往更年轻和/或接受了开放手术。
