Shirazi Mehdi, Aminsharifi Alireza, Ahmed Faisal, Makarem Alireza, Zahraei Seyed Alihossein, Asmaarian Naeimehossadat
Department of Urology, Shiraz University of Medical Science, Shiraz, Iran.
Division of Urology, Duke University Hospital, Durham, NC, USA.
Med J Islam Repub Iran. 2020 Aug 25;34:105. doi: 10.34171/mjiri.34.105. eCollection 2020.
To evaluate the outcome of retrograde endopyelotomy as a minimally invasive option for management of failed open pyeloplasty in children and assess how the duration of post-procedural stenting may affect the endopyelotomy outcome. A total of 15 patients with secondary UPJO (Ureteropelvic junction obstruction) underwent retrograde endopyelotomy. The procedure was done using low-energy monopolar electrocautery hook under direct vision of pediatric ureteroscope and control of fluoroscopy. Double J stent was placed after the operation in all cases. Stent was removed in another session, 8 weeks (Group A, n=7) vs. 12 weeks (Group B, n=8) after endopyelotomy. Patients in both Groups were followed one, six and twelve months after the stent removal, and the anteroposterior renal pelvis diameter (APD), renal cortical thickness (CT) and degree of hydronephrosis (HDN) were recorded using the repeated measure test. P-value less than 0.05 were significant. We analyzed the data using SPSS software, version 20. The median interquartile range (IQR) age at time of surgery for group A and B were 24 (62) months and 12 (50) months respectively. Median (IQR) times between previous pyeloplasty and endopyelotomy were 6 (6) months and 12 (8.5) months in groups A and B, respectively. The success rate of endopyelotomy after 12 months was 57.1% in group A and 87.5% in group B. The resolution of HDN was more prominent in the 12 week stenting group compared to the 8 week group during the 12 months follow-up period (p=0.030). The APD and CT in group B compared to group A was improved during follow-up period. A higher one-year success rate of retrograde endopyelotomy in terms of improvements in the degree of HDN, APD and CT was observed when the double j stent was remained for 12-weeks rather than 8-weeks. This observation need to be validated in a large cohort study with a long term post procedural follow up.
评估逆行肾盂内切开术作为儿童开放性肾盂成形术失败后的一种微创治疗选择的效果，并评估术后支架置入时间对肾盂内切开术效果的影响。共有15例继发性肾盂输尿管连接部梗阻（UPJO）患者接受了逆行肾盂内切开术。该手术在小儿输尿管镜直视和荧光透视控制下，使用低能量单极电灼钩完成。所有病例术后均放置双J支架。在肾盂内切开术后8周（A组，n = 7）与12周（B组，n = 8）的另一次手术中取出支架。两组患者在支架取出后1个月、6个月和12个月进行随访，采用重复测量试验记录肾盂前后径（APD）、肾皮质厚度（CT）和肾积水程度（HDN）。P值小于0.05具有显著性。我们使用SPSS 20.0软件分析数据。A组和B组手术时的年龄中位数（四分位间距[IQR]）分别为24（62）个月和12（50）个月。A组和B组上次肾盂成形术与肾盂内切开术之间的时间中位数（IQR）分别为6（6）个月和12（8.5）个月。12个月后肾盂内切开术的成功率在A组为57.1%，在B组为87.5%。在12个月的随访期内，12周支架置入组的肾积水消退比8周组更显著（p = 0.030）。随访期间，B组的APD和CT与A组相比有所改善。当双J支架保留12周而非8周时，逆行肾盂内切开术在改善HDN程度、APD和CT方面的一年成功率更高。这一观察结果需要在一项长期术后随访的大型队列研究中得到验证。
