University of Health Sciences, Zeynep Kamil Maternity and Children's Diseases Health Training and Research Center, Department of the Pediatric Surgery, Istanbul, Turkey.
Urol J. 2020 Apr 19;18(1):81-85. doi: 10.22037/uj.v0i0.5531.
The aim of this study was to assess the safety and the efficiency of pyeloplasty in infants with ureteropelvic junction obstruction (UPJO) in the first six weeks of their life.
Clinical records of the patients who had surgery during first six weeks of life for UPJO between June 2009 and June 2014 were analysed retrospectively.
In this period, twenty-six dismembered pyeloplasties were performed in twenty-four patients on mean operation age of 27.3 ± 10.2 days (range 8-42 days). On the first postnatal ultrasound all twenty-six renal units had SFU-4 hydronephrosis. Mean preoperative and postoperative anterior-posterior pelvic diameter and parenchymal thickness were 33.1 ± 8.9mm (range 14-49mm), 3.2 ± 1mm (range 1-4,6mm) and 14.7 ± 6.6mm (range 6-27mm) and 7.8 ± 1.9mm (range 3.0-10.4mm), respectively. The differences between preoperative and postoperative parenchymal thickness and anterior-posterior pelvic diameter were statistically significant (P ˂ 0.0001). Preoperative MAG3 dynamic renal scintigraphy showed obstructive pattern on the diuretic renogram in 26 units. Mean preoperative and postoperative differential renal function on dynamic renal scintigraphy of the affected renal units were 46 ± 15 and 44 ± 15, respectively. Postoperative drainage was normal on dynamic renal scintigraphy in 25 (96.2%) of the 26 units, redo-pyeloplasty was needed in only one unit (3.8%).
In conclusion, patient selection and timing of surgery are very important in the protection of renal function in newborn with UPJO. In our opinion, if there is indication for surgery, early surgical intervention should not postpone in this period. Surgical treatment of UPJO during first six weeks of life is safe and effective.
本研究旨在评估婴儿肾盂输尿管连接部梗阻（UPJO）在出生后六周内接受肾盂成形术的安全性和有效性。
回顾性分析 2009 年 6 月至 2014 年 6 月期间，出生后六周内接受 UPJO 手术的 24 例患者的临床资料。
在此期间，24 例患者共行 26 例离断式肾盂成形术，手术平均年龄为 27.3 ± 10.2 天（8-42 天）。在出生后第一次超声检查时，26 个肾单位均有 SFU-4 积水。术前和术后的前后径和实质厚度分别为 33.1 ± 8.9mm（14-49mm）、3.2 ± 1mm（1-4.6mm）和 14.7 ± 6.6mm（6-27mm）和 7.8 ± 1.9mm（3.0-10.4mm）。前后径和实质厚度的术前与术后差值均有统计学意义（P ˂ 0.0001）。术前 MAG3 动态肾闪烁显像在利尿肾图上显示 26 个单位存在梗阻模式。26 个受累肾单位的术前和术后动态肾闪烁显像的分肾功能分别为 46 ± 15 和 44 ± 15。26 个单位中有 25 个（96.2%）的动态肾闪烁显像术后引流正常，仅 1 个单位（3.8%）需要再次肾盂成形术。
总之，患者的选择和手术时机对保护新生儿 UPJO 中的肾功能非常重要。在我们看来，如果有手术指征，在此期间不应推迟早期手术干预。出生后六周内治疗 UPJO 是安全有效的。
