Ross J H, Kay R, Knipper N S, Streem S B
Department of Urology, Cleveland Clinic Foundation, Ohio, USA.
J Urol. 1998 Sep;160(3 Pt 2):973-5; discussion 994. doi: 10.1097/00005392-199809020-00001.
The widespread use of prenatal ultrasonography has led to a marked increase in the incidence of ureteropelvic junction obstruction presenting in infancy. Which of these prenatally detected lesions requires repair has yet to be fully determined. Attempts to characterize prenatally detected ureteropelvic junction obstruction in regard to symptomatic obstruction detected later in life may provide useful insights into the management of these incidentally discovered lesions. We evaluated the presence of crossing vessels in ureteropelvic junction obstruction identified by prenatal ultrasonography.
We reviewed the records of patients who underwent dismembered pyeloplasty for primary ureteropelvic junction obstruction with specific attention to the mode of presentation and presence of crossing vessels associated with obstruction.
In 30 patients with a mean age of 6 months ureteropelvic junction obstruction detected prenatally was not associated with a crossing vessel. Ureteropelvic junction obstruction was identified postnatally in 125 patients who underwent open pyeloplasty. It was detected incidentally in 8, of whom crossing vessels were present in 1 (12%). There were signs or symptoms related to ureteropelvic junction obstruction in 117 patients. In contrast to the group with prenatally detected ureteropelvic junction obstruction in which crossing vessels were never noted, crossing vessels were associated with 36 (30%) of the 120 kidneys operated on in this postnatally discovered group.
No crossing vessels were present in patients with prenatally detected ureteropelvic junction obstruction compared with 30% in symptomatic patients. This finding may reflect the natural history of the disorder, or it may suggest that prenatally identified ureteropelvic junction obstruction is an entity largely different from obstruction presenting later in life.
产前超声检查的广泛应用导致婴儿期肾盂输尿管连接部梗阻的发病率显著增加。这些产前检测到的病变中哪些需要修复尚未完全确定。尝试根据生命后期检测到的症状性梗阻来表征产前检测到的肾盂输尿管连接部梗阻，可能会为这些偶然发现的病变的管理提供有用的见解。我们评估了产前超声检查发现的肾盂输尿管连接部梗阻中交叉血管的存在情况。
我们回顾了因原发性肾盂输尿管连接部梗阻接受肾盂成形术患者的记录，特别关注其表现方式以及与梗阻相关的交叉血管的存在情况。
30例产前检测到肾盂输尿管连接部梗阻的患者，平均年龄6个月，其梗阻与交叉血管无关。125例行开放性肾盂成形术的患者在出生后被诊断出肾盂输尿管连接部梗阻。其中8例为偶然发现，1例（12%）存在交叉血管。117例患者有与肾盂输尿管连接部梗阻相关的体征或症状。与产前检测到肾盂输尿管连接部梗阻且从未发现交叉血管的组相比，在出生后发现的这组接受手术的120个肾脏中，36个（30%）与交叉血管有关。
产前检测到肾盂输尿管连接部梗阻的患者中不存在交叉血管，而有症状的患者中这一比例为30%。这一发现可能反映了该疾病的自然病程，或者可能表明产前诊断出的肾盂输尿管连接部梗阻在很大程度上是一种与生命后期出现的梗阻不同的实体。
