Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran.
Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Pediatr Surg Int. 2023 Mar 7;39(1):147. doi: 10.1007/s00383-023-05434-w.
Ureteropelvic junction obstruction is a relatively common urologic problem in children. Most cases present with pelvicaliceal dilatation in antenatal period. Historically most UPJO cases were treated with surgical procedures, but recently many of these children have been treated by nonsurgical observational plans. We compared the outcome of children with UPJO treated in surgical and observational ways.
In a retrospective study, we assessed the medical history of patients diagnosed as UPJO, march 2011 to march 2021. The case definition was based on grade 3-4 hydronephrosis and obstructive pattern in dynamic renal isotopes can. Patients were put into two groups; Group 1 children were treated with a surgical procedure, and group 2 patients without any surgical procedure for at least a six months' period after diagnosis. We assessed long-term events and improvement of obstruction.
Seventy-eight children (mean age 7.32mo., 80% male) enrolled in the study, 55 patients in group one and 23 as group 2. Severe hydronephrosis was the problem of 96% of all patients significantly led to 20% in group 1 and 9% in group 2 (P < 0.001). Severe kidney involvement was observed at 91% in group 1 and 83% in group 2, decreased to 15% and 6%, respectively (P < 0.001). There were no significant differences in sonographic and functional improvement between the two intervention groups. Long-term prognostic issues; growth, functional impairment, and hypertension were not different between the two groups, but group 1 children experienced more recurrence of UTI than group 2 patients.
Conservative management is as effective as early surgical treatment in the management of infants with severe UPJO.
肾盂输尿管连接部梗阻是儿童中相对常见的泌尿科问题。大多数病例在产前出现肾盂肾盏扩张。历史上，大多数 UPJO 病例采用手术治疗，但最近许多此类儿童采用非手术观察性方案进行治疗。我们比较了手术和观察性治疗的 UPJO 患儿的结局。
在一项回顾性研究中，我们评估了 2011 年 3 月至 2021 年 3 月间被诊断为 UPJO 的患者的病史。病例定义基于 3-4 级肾动态同位素扫描的积水和梗阻模式。患者分为两组；第 1 组患儿采用手术治疗，第 2 组患儿在诊断后至少 6 个月内不进行任何手术。我们评估了长期事件和梗阻改善情况。
共有 78 名儿童（平均年龄 7.32 个月，80%为男性）入组本研究，其中 55 名患儿在第 1 组，23 名患儿在第 2 组。96%的所有患者均存在严重肾积水，其中 20%的患者在第 1 组，9%的患者在第 2 组（P<0.001）。第 1 组患儿中有 91%的患儿存在严重的肾脏受累，第 2 组患儿中有 83%的患儿存在严重的肾脏受累，分别下降至 15%和 6%（P<0.001）。两组干预组的超声和功能改善无显著差异。长期预后问题；生长、功能损害和高血压在两组之间无差异，但第 1 组患儿比第 2 组患儿更易发生尿路感染复发。
对于严重 UPJO 婴儿，保守治疗与早期手术治疗同样有效。
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