Management of Severe Bilateral Ureteropelvic Junction Obstruction in Neonates with Prenatally Diagnosed Bilateral Hydronephrosis

被引：11

作者：

Kim, Jongwon ^{[1
]}

Hong, Sungwoo ^{[1
]}

Park, Chang Hoo ^{[3
]}

Park, Hongzoo ^{[2
]}

Kim, Kun Suk ^{[1
]}

机构：

[1] Univ Ulsan, Coll Med, Dept Urol, Seoul, South Korea

[2] Univ Ulsan, Coll Med, Kangnung, South Korea

[3] Kangwon Natl Univ, Sch Med, Chunchon, South Korea

来源：

KOREAN JOURNAL OF UROLOGY | 2010年 / 51卷 / 09期

关键词：

Hydronephrosis; Ultrasonography; Ureteral obstruction;

D O I：

10.4111/kju.2010.51.9.653

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：

Purpose: The management of prenatally detected bilateral ureteropelvic junction obstruction (UPJO) remains controversial. We attempted to develop a treatment plan for patients with severe bilateral UPJO. Materials and Methods: We evaluated the records of 13 patients with prenatally diagnosed grade 3 or more bilateral hydronephrosis that led to the postnatal diagnosis of severe bilateral UPJO. Ultrasonography and (99m)technetium mercaptoacetyltriglycine (Tc-99m-MAG3) renal scans were performed within 1 month. Four renal units had grade 3 and 22 had grade 4 hydronephrosis. All 13 patients were managed by unilateral pyeloplasty, and the patients' mean age was 3 months. At 1 month postoperatively, we decided whether delayed surgery in the opposite renal unit was necessary according to the findings of ultrasonography and Tc-99m-MAG3 scans. Results: Of 13 patients, 11 underwent initial pyeloplasty on renal units with more severe hydronephrosis or lower relative renal function (RRF) on Tc-99m-MAG3 scans. The remaining 2 patients simultaneously underwent percutaneous nephrostomy on renal units with a lower RRF and initial pyeloplasty on renal units with a higher RRF. In 5 patients, contralateral hydronephrosis had spontaneously improved at 1 month postoperatively, and 8 patients underwent delayed contralateral pyeloplasty at 2 months postoperatively. Conclusions: In children with severe bilateral UPJO, the non- operated renal units with grade 3 and some with grade 4 hydronephrosis improved spontaneously after unilateral pyeloplasty. Therefore, delayed pyeloplasty of the opposite side should be considered at 1 month following initial pyeloplasty.

引用

页码：653 / 656

页数：4

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