Shao Zikun, Yang Zhenzhen, Li Jiayi, Liu Pei, Song Hongcheng, Yang Yang, Li Zhenwu, Sun Ning, Xie Xianghui, Zhang Weiping, Li Ning
Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China.
Transl Androl Urol. 2023 Dec 31;12(12):1803-1812. doi: 10.21037/tau-23-406. Epub 2023 Dec 19.
Horseshoe kidney (HSK) represents a unique challenge for performing pyeloplasty due to its anomalous anatomy. Our study aimed to report our results in treating children with hydronephrosis in HSK and to investigate the differences in prognosis based on the cause of obstruction and the surgical approach. We also aimed to share our experiences by characterizing the success rates and complications after surgery.
We retrospectively reviewed the clinical data of hydronephrosis patients with HSK who were treated with pyeloplasty from August 2009 to June 2022. The patients were grouped according to different surgical methods and causes of obstruction, and then the clinical characteristics and outcomes were analyzed.
Thirty-one patients were included in this retrospective cohort observational study, and surgical success was achieved in 80.6% (25/31) of patients. There was no significant difference in complications between open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) groups (2/16 4/15, P=0.374). At 6 and 12 months postoperatively, both OP and LP groups experienced a decrease in anteroposterior pelvic diameter (APD) and the ratio of APD to the thickness of renal parenchyma (P/C ratio), accompanied by an increase in renal parenchymal thickness. Two patients of reobstruction were caused by missed crossing vessels in primary operation. The success rate of patients with crossing vessels (62.5%) was significantly lower than that of patients without crossing vessels (100%) (P=0.018).
Our study found that intrinsic obstruction, crossing vessels, and high insertion were the main causes of hydronephrosis in HSK, with missed crossing vessels being the primary cause of reobstruction. Our results demonstrate that both OP and LP are safe and effective in treating hydronephrosis in HSK patients.
马蹄肾（HSK）因其解剖结构异常，给肾盂成形术带来了独特的挑战。我们的研究旨在报告治疗马蹄肾合并肾积水患儿的结果，并根据梗阻原因和手术方式探讨预后差异。我们还旨在通过描述手术成功率和术后并发症来分享经验。
我们回顾性分析了2009年8月至2022年6月期间接受肾盂成形术治疗的马蹄肾合并肾积水患者的临床资料。根据不同的手术方法和梗阻原因对患者进行分组，然后分析临床特征和结局。
本回顾性队列观察研究共纳入31例患者，80.6%（25/31）的患者手术成功。开放性肾盂成形术（OP）组和腹腔镜肾盂成形术（LP）组的并发症发生率无显著差异（2/16对4/15，P=0.374）。术后6个月和12个月，OP组和LP组的肾盂前后径（APD）以及APD与肾实质厚度之比（P/C比）均下降，同时肾实质厚度增加。2例再梗阻患者是由初次手术时遗漏交叉血管所致。有交叉血管患者的成功率（62.5%）显著低于无交叉血管患者（100%）（P=0.018）。
我们的研究发现，内在梗阻、交叉血管和高位肾盂是马蹄肾合并肾积水的主要原因，遗漏交叉血管是再梗阻的主要原因。我们的结果表明，OP和LP在治疗马蹄肾患者肾积水方面均安全有效。
