Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Hospital Sírio Libanês, São Paulo, Brazil.
Scand J Urol. 2021 Jun;55(3):192-196. doi: 10.1080/21681805.2021.1879929. Epub 2021 Feb 1.
To compare symptom resolution and short-term renal function after pyeloplasty or nephrectomy in adults with ureteropelvic junction obstruction (UPJO) in poorly functioning renal units (PFRU).
Retrospective analysis of adult patients with UPJO and differential renal function (DRF) ≤ 15% who underwent laparoscopic pyeloplasty or nephrectomy. Primary endpoints included symptom resolution and estimated glomerular filtration rate (eGFR) at 12 months. Surgical complications were compared between groups. A secondary analysis was performed comparing baseline and postoperative DRF to evaluate the PFRU recovery potential after pyeloplasty.
Sixty-three patients were included; 19 underwent pyeloplasty and 44 underwent nephrectomy. The mean age of the cohort was 39.5 ± 13.8 years. Nephrectomy was associated with significantly higher intra-operative blood loss ( = 0.02). Operative time and length of hospital stay were not significantly different between groups. There were three complications in the nephrectomy group, and none in the pyeloplasty group ( = 0.34). Symptom resolution rates were equivalent between groups (73% vs. 76%; = 0.78). The eGFR variation was not statistically different after pyeloplasty or nephrectomy (+6.2 vs. +0.1 mL/min/1.73m, respectively; = 0.18). Patients undergoing pyeloplasty had no significant change in the mean DRF (baseline 9.5 vs. 10%; = 0.99).
Pyeloplasty can be considered for selected patients with UPJO in PFRU as an organ-sparing alternative to nephrectomy. Although there was no significant gain in mean DRF, pyeloplasty prevented further functional loss and relieved symptoms in most cases in the short-term with at least the same complication rates of nephrectomy.
比较肾盂成形术与肾切除术治疗功能不良肾单位（PFRU）中输尿管肾盂连接部梗阻（UPJO）患者的症状缓解和短期肾功能。
回顾性分析接受腹腔镜肾盂成形术或肾切除术治疗且差异肾功能（DRF）≤15%的 UPJO 成年患者。主要终点包括 12 个月时的症状缓解和估算肾小球滤过率（eGFR）。比较两组之间的手术并发症。进行了一项次要分析，比较基线和术后 DRF 以评估肾盂成形术后 PFRU 的恢复潜力。
共纳入 63 例患者，19 例行肾盂成形术，44 例行肾切除术。队列的平均年龄为 39.5±13.8 岁。肾切除术术中出血量明显更高（ = 0.02）。手术时间和住院时间在两组间无显著差异。肾切除术组有 3 例并发症，肾盂成形术组无并发症（ = 0.34）。两组的症状缓解率相当（73%比 76%； = 0.78）。肾盂成形术或肾切除术对 eGFR 的影响无统计学差异（分别增加 6.2 与 0.1 mL/min/1.73m ； = 0.18）。行肾盂成形术的患者 DRF 均值无显著变化（基线为 9.5%比 10%； = 0.99）。
对于 PFRU 中的 UPJO 患者，肾盂成形术可以作为肾切除术的一种保肾替代方法。虽然 DRF 均值没有显著增加，但肾盂成形术在短期内预防了大多数患者的进一步功能丧失，并缓解了症状，其并发症发生率与肾切除术至少相同。
