Carpenter Christina P, Tolley Elizabeth, Tourville Elizabeth, Sharadin Cynthia, Giel Dana W, Gleason Joseph M
Department of Urology, Division of Pediatric Urology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN; Department of Urology, Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, NY.
Department of Preventive Medicine, Biostatistics & Epidemiology, University of Tennessee Health Science Center, Memphis, TN.
Urology. 2018 Nov;121:158-163. doi: 10.1016/j.urology.2018.08.010. Epub 2018 Aug 18.
To identify attributes of pediatric patients with hydronephrosis due to ureteropelvic junction obstruction and of their surgical encounters which are predictive of resolution of dilatation in order to provide more effective counseling about expected outcomes. This study was inspired by the suggestion in recent literature that greater than 20% improvement in anteroposterior diameter (APD) of the renal pelvis after pyeloplasty is indicative of resolution of obstruction. The remaining dilatation, however, is often distressing to caregivers, and there are no data to guide clinicians in counseling about its likelihood to resolve.
We retrospectively reviewed children who underwent surgery at our institution for ureteropelvic junction obstruction between 1/01/2010 and 6/30/2017. APD of the pre- (preAPD) and postoperative (postAPD) renal pelves were documented. In children with more than 1 postoperative ultrasound, lastAPD was the measurement on their most recent study. Appropriate statistical tests examined the effects of clinical and surgical variables on hydronephrosis resolution.
PostAPD and lastAPD were obtained at medians of 3 months and 1.9 years after surgery, and were 0 cm in 12 of 105 (11.5%) and 9 of 65 (13.8%) patients, respectively. None of the variables analyzed significantly impacted complete resolution at either time point. Of those that did not resolve, 80.6% (75/93) showed greater than 20% improvement in APD; however, 3 of these children required reoperation due to secondary obstruction. In our study, no one with APD reduction greater than 43% required reintervention.
Complete resolution of hydronephrosis is uncommon and unpredictable. All caregivers should be counseled to expect dilatation to persist after obstruction is corrected.
确定因肾盂输尿管连接处梗阻导致肾积水的儿科患者及其手术情况的特征，这些特征可预测扩张的消退情况，以便就预期结果提供更有效的咨询。本研究受到近期文献中一项建议的启发，即肾盂成形术后肾盂前后径（APD）改善超过20%表明梗阻已解除。然而，剩余的扩张往往让护理人员感到困扰，且尚无数据指导临床医生就其消退可能性进行咨询。
我们回顾性分析了2010年1月1日至2017年6月30日期间在我院因肾盂输尿管连接处梗阻接受手术的儿童。记录术前（preAPD）和术后（postAPD）肾盂的APD。在术后接受多次超声检查的儿童中，lastAPD是其最近一次检查的测量值。采用适当的统计检验来研究临床和手术变量对肾积水消退的影响。
postAPD和lastAPD分别在术后3个月和1.9年的中位数时间获得，105例患者中有12例（11.5%）、65例患者中有9例（13.8%）的测量值为0 cm。在两个时间点，所分析的变量均未对完全消退产生显著影响。在未消退的患者中，80.6%（75/93）显示APD改善超过20%；然而，其中3名儿童因继发性梗阻需要再次手术。在我们的研究中，APD降低超过43%的患者均无需再次干预。
肾积水完全消退并不常见且不可预测。应告知所有护理人员，在梗阻纠正后，预计扩张仍会持续。
