Bratt C G, Aurell M, Granérus G, Nilsson S
Scand J Urol Nephrol. 1983;17(3):329-35. doi: 10.3109/00365598309182141.
A series of 91 cases of unilateral obstruction of the pelviureteric junction is reviewed. Primary nephrectomy was performed in 13 cases (14%) because of severe hydronephrosis and renal function less than 10% that of the normal kidney. Pyeloplasty was performed according to Anderson-Hynes in 74 cases and with a Culp-De Weerd flap in four cases. Nephrostomy was performed concomitantly with the pyeloplasty in 14 cases. The parenchymal function was normal before pyeloplasty in 78% of the 78 kidneys, though the drainage function was severely impaired in 76 of the kidneys and moderately impaired in two. Urine cultures were positive before pyeloplasty in two patients, and 13 of the treated kidneys contained calculi. Follow-up examination was performed 5 to 12 years (mean 8.5 years) after pyeloplasty in all 78 patients. Of the 17 kidneys with preoperatively impaired parenchymal function, 12 (71%) showed improvement. The drainage function was improved in 68 (91%) of the 75 studied kidneys. Persistently impaired drainage function after pyeloplasty was found only in kidneys with infection secondary to retrograde passage of a ureteral catheter for treatment of postoperative urinary leakage. Urinary infection occurred in 11 of the 33 cases with such leakage. Retrograde ureteral catheterization thus favoured the occurrence of urinary infection. Its importance as a risk factor for severe infection was shown by the necessity for secondary nephrectomy in three cases. Since nephrostomy tended to reduce the incidence of urinary leakage, and thereby the need for indwelling ureteral catheter, and since nephrostomy as such was not associated with urinary infection, we recommend its use in the management of idiopathic hydronephrosis.
回顾了91例肾盂输尿管连接处单侧梗阻的病例。13例（14%）因严重肾积水且肾功能低于正常肾脏的10%而进行了一期肾切除术。74例根据安德森 - 海因斯法进行肾盂成形术，4例采用卡尔普 - 德韦德皮瓣法进行肾盂成形术。14例在肾盂成形术的同时进行了肾造瘘术。78个肾脏中，78%的肾脏在肾盂成形术前实质功能正常，尽管其中76个肾脏的引流功能严重受损，2个肾脏中度受损。2例患者在肾盂成形术前尿培养呈阳性，13个接受治疗的肾脏中有结石。对所有78例患者在肾盂成形术后5至12年（平均8.5年）进行了随访检查。17个术前实质功能受损的肾脏中，12个（71%）有所改善。75个接受研究的肾脏中，68个（91%）的引流功能得到改善。仅在因输尿管导管逆行插入治疗术后尿漏继发感染的肾脏中发现肾盂成形术后引流功能持续受损。33例有这种尿漏的病例中，11例发生了泌尿系统感染。因此，逆行输尿管插管有利于泌尿系统感染的发生。3例因严重感染而进行二期肾切除术表明了其作为严重感染危险因素的重要性。由于肾造瘘术倾向于降低尿漏的发生率，从而减少留置输尿管导管的必要性，并且由于肾造瘘术本身与泌尿系统感染无关，我们建议在特发性肾积水的治疗中使用肾造瘘术。
