Predicting the Clinical Outcome of Antenatally Detected Unilateral Pelviureteric Junction Stenosis

被引:42
作者
Hong Phuoc Duong
Piepsz, Amy
Collier, Frank
Khelif, Karim
Christophe, Catherine
Cassart, Marie
Janssen, Francoise
Hall, Michelle
Ismaili, Khalid
机构
[1] Univ Libre Brussels, Queen Fabiola Childrens Hosp, Dept Pediat Nephrol, Brussels, Belgium
[2] St Pierre Univ Hosp, Dept Radioisotopes, Brussels, Belgium
[3] Univ Libre Brussels, Queen Fabiola Childrens Hosp, Dept Pediat Urol, Brussels, Belgium
[4] Univ Libre Brussels, Queen Fabiola Childrens Hosp, Dept Pediat Radiol, Brussels, Belgium
[5] Univ Libre Brussels, Erasme Hosp, Dept Radiol, B-1050 Brussels, Belgium
关键词
DIURETIC RENOGRAPHY; RENAL PELVIS; HYDRONEPHROSIS; DILATATION;
D O I
10.1016/j.urology.2013.03.041
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To determine, in children with antenatally detected pelviureteric junction (PUJ) stenosis, what factors may be predictive for deterioration of differential renal function (DRF) in case of conservative treatment or improvement of DRF in case of pyeloplasty. METHODS This study analyzed and compared the initial level of hydronephrosis, DRF, quality of renal drainage, and cortical transit with the late DRF outcome. We reviewed the medical charts of 161 consecutive children with antenatally diagnosed PUJ stenosis during a 10-year period (between 1997 and 2007). From this cohort, we retained 81 children with unilateral PUJ and strictly normal contralateral kidney, with a median follow-up of 67 months. Repeated ultrasounds, voiding cystourethrography, and radionuclide renograms were performed in all children. RESULTS Fifty patients never underwent a surgical intervention (62%), whereas surgical repair (Anderson-Hynes dismembered pyeloplasty) was performed in 31 (38%). During conservative follow-up, DRF deterioration was observed in 11% of patients. After pyeloplasty, DRF improvement was observed in 25% of patients. Abnormal cortical transit was the only predictive factor of DRF deterioration in case of conservative approach, whereas the initial degree of hydronephrosis, or renal drainage, and the initial DRF level were not predictive. In children who were operated on, only impaired cortical transit was predictive of DRF improvement postoperatively. CONCLUSION Conservative management of children with unilateral PUJ stenosis is a safe procedure. Impaired cortical transit although imperfect, seems the best criterion for identifying children for whom pyeloplasty is warranted. (c) 2013 Elsevier Inc.
引用
收藏
页码:691 / 696
页数:6
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