Kord Eyal, Neeman Binyamin B, Perez Dolev, Chertin Boris, Zisman Amnon, Neheman Amos
Department of Urology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, P.O. Box 70300, Zerifin, Israel.
Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Ther Adv Urol. 2023 May 19;15:17562872231172835. doi: 10.1177/17562872231172835. eCollection 2023 Jan-Dec.
Evidence regarding the impact of perinatal ureteropelvic junction obstruction (UPJO) and surgical correction during infancy, on somatic growth are scarce. Understanding these impacts could help advise parents and aid in treatment decision making.
To assess the impact of unilateral UPJO and surgical correction on somatic growth in infants diagnosed antenatally and treated during infancy.
A retrospective bi-institutional analysis of somatic growth in patients under 2 years who underwent dismembered pyeloplasty for the treatment of UPJO was conducted.
We evaluated patients who were diagnosed with unilateral hydronephrosis during pre-natal ultrasound screening for detection of fetal anomalies between May 2015 and October 2020. The height and weight of patients who were diagnosed with UPJO were recorded at the age of 1 month, time of surgery, and 6 months after surgery. Standard deviation scores (SDSs) for height and weight were calculated and compared.
Forty-eight patients under the age of 2 years were included in the analysis. Median age and weight at pyeloplasty were 6.9 months and 7.5 kg. At 1 month, the median SDS for weight in the entire cohort was -0.30 [interquartile range (IQR): -1.0 to 0.63] and the median SDS for height was -0.26 (IQR: -1.08 to 0.52). In 22.9% of patients (11/48), weight and height were below -1 age-appropriate standard deviations, and 6.3% (3/48) were below -2 standard deviations, suggesting growth restriction. When comparing SDS for the entire cohort, there was no significant difference corelated to measurement time or effect of surgery. In the growth restricted cohort, we found a significant improvement in linear growth for height, which was demonstrated between birth and surgery as well as after surgery.
Infants with unilateral UPJO diagnosed antenatally as a single anomaly may be at an increased risk of somatic growth restriction in comparison with the general population. In children with growth restriction at time of birth, height seems to improve regardless of surgical treatment. Pyeloplasty during infancy does not seem to negatively affect somatic growth. These findings can be used to counsel parents regarding the potential effects of UPJO and pyeloplasty.
关于围产期肾盂输尿管连接部梗阻（UPJO）及其婴儿期手术矫正对身体生长影响的证据很少。了解这些影响有助于为家长提供建议并辅助治疗决策。
评估单侧UPJO及其手术矫正对产前诊断并在婴儿期接受治疗的婴儿身体生长的影响。
对2岁以下因UPJO接受肾盂成形术治疗的患者的身体生长情况进行回顾性双机构分析。
我们评估了2015年5月至2020年10月期间在产前超声筛查胎儿异常时被诊断为单侧肾积水的患者。记录被诊断为UPJO的患者在1个月龄、手术时和术后6个月时的身高和体重。计算并比较身高和体重的标准差分数（SDS）。
48例2岁以下患者纳入分析。肾盂成形术时的中位年龄和体重分别为6.9个月和7.5千克。在1个月时，整个队列体重的中位SDS为-0.30[四分位间距（IQR）：-1.0至0.63]，身高的中位SDS为-0.26（IQR：-1.08至0.52）。22.9%的患者（11/48）体重和身高低于适合年龄的-1个标准差，6.3%（3/48）低于-2个标准差，提示生长受限。比较整个队列的SDS时，未发现与测量时间或手术效果相关的显著差异。在生长受限队列中，我们发现身高的线性生长有显著改善，这在出生至手术期间以及术后均有体现。
与一般人群相比，产前作为单一异常被诊断为单侧UPJO的婴儿可能有更高的身体生长受限风险。对于出生时生长受限的儿童，无论手术治疗如何，身高似乎都会改善。婴儿期肾盂成形术似乎不会对身体生长产生负面影响。这些发现可用于为家长提供关于UPJO和肾盂成形术潜在影响的咨询。
