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Problems in severe bilateral urinary tract anomalies
1University Clinic of Paediatric Surgery, Rigshopitalet, Copenhagen, Denmark.
Insights
Managing severe urinary tract obstruction in children is challenging. Early diagnosis and careful intervention are crucial for preserving renal function, as some cases have limited recovery potential.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Abnormalities
Background:
- Severe infravesical or bilateral ureterovesical obstruction presents management difficulties in children.
- Congenital urinary tract obstruction can lead to significant renal impairment at diagnosis.
Purpose of the Study:
- To review the long-term outcomes of managing children with severe urinary tract obstruction.
- To assess the impact of obstruction on renal function and the effectiveness of interventions.
Main Methods:
- Retrospective analysis of 29 children with severe infravesical or bilateral ureterovesical obstruction over 10 years.
- Evaluation of renal function, surgical interventions (nephrectomies, urinary diversions), and patient outcomes.
Main Results:
- 19 children presented in the first 3 months of life; 13 had severe renal function disturbance at diagnosis.
- Two deaths occurred. Long-term renal function varied, with 7 children experiencing reduced function.
- Ten nephrectomies and eleven urinary diversions were performed; four permanent diversions were reversed.
Conclusions:
- Management of severe urinary tract obstruction in children is complex, with potential for irreversible renal damage.
- Renal dysplasia and developmental ureterovesical abnormalities may limit functional recovery.
- Careful, timely management, particularly in neonates, is essential to optimize outcomes and minimize complications.
Abstract:
Management of children with severe infravesical or bilateral ureterovesical obstruction with or without reflux is difficult. Our experience over 10 years includes 29 such children, 19 of whom presented in the first 3 months of life. At the time of diagnosis, 13 had severe disturbance of renal function. There were two deaths. Five children have severe and two a moderate reduction of renal function; twenty good renal function. There were ten nephrectomies and four heminephrectomies. Seven patients had a temporary and eight a permanent urinary diversion. However, four of the latter were later undiverted. Removal of an obstruction is not always followed by full restitution of function. It seems probable that renal dysplasia and developmental injury to the ureterovesical musculature set a limit to the therapeutic possibilities. Careful management is important, especially in neonatal cases, where extensive reconstructive procedures are technically demanding and the rate of complications is high.