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Published on: November 30, 2010
[Prevention of perioperative complications in children with congenital uropathies]
O L Morozova1,2, D A Morozov1,2, D Y Lakomova1,2
1Sechenov First Moscow State Medical University, Moscow, Russia.
Insights
Preoperative immunomodulators and probiotics significantly reduce postoperative complications in children with congenital uropathies. These treatments mitigate inflammation and dysbiosis, improving patient outcomes after surgery.
Area of Science:
- Pediatric Surgery
- Immunology
- Gastroenterology
Background:
- Congenital uropathies (CU) in children often require surgical intervention.
- Preoperative preparation is crucial for managing potential complications like inflammation and dysbiosis.
- Optimizing preoperative strategies can improve surgical outcomes in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of immunomodulators and probiotics in preoperative preparation for children with congenital uropathies.
- To determine if these agents can pathogenetically improve outcomes by reducing inflammation and dysbiosis.
- To compare the effects of specific immunomodulators (Kipferon) and probiotics (Bifidum No791 BAG) against standard care.
Main Methods:
- A study involving 60 children with congenital uropathies (vesicoureteral reflux, hydronephrosis).
- Patients were divided into three groups: immunomodulator (Kipferon), probiotic (Bifidum No791 BAG), and control (standard care).
- Urine samples were analyzed for pro-inflammatory (IL-8) and anti-inflammatory (IL-10) cytokines using ELISA before and after surgery.
Main Results:
- All groups showed signs of pyelonephritis post-surgery, but it was most pronounced in the control group.
- Dysbiosis was observed 20% more frequently in the control group compared to the probiotic group.
- While IL-8 increased in all groups, IL-10 elevation was most significant in the immunomodulator and probiotic groups, with lower inflammation indices.
Conclusions:
- The use of immunomodulators and probiotics in preoperative preparation for pediatric obstructive uropathies is beneficial.
- These agents effectively reduce the risk, severity, and duration of postoperative complications.
- Targeted preoperative therapy with immunomodulators or probiotics enhances recovery and minimizes inflammatory responses.
Aim:
To substantiate the expediency of immunomodulators and probiotics application pathogenetically in the comprehensive preoperative preparation in children with congenital uropathies (U).
Materials And Methods:
The study includes 60 patients with various types of congenital uropathy (CU) (vesicoureteral reflux, hydronephrosis, obstructive ureterohydronephrosis), which were divided into 3 groups in accordance with the preoperative preparation complex. 1 group - 20 patients with VU, immunomodulating drug Kipferon was added to the therapy at the preoperative stage, group 2 - 20 patients with VU - with the addition of the biologically active additive (BAA) "Bifidum No791 BAG", 3 control group - 20 children with VU standard complex of preoperative preparation. The diagnosis of VU was established using a standard urological examination. The examination of the content of pro-(IL-8) and anti-inflammatory (IL-10) cytokines in the urine was performed before the start of treatment (1 point) and on the 3-5th day after surgery (2 point) for all patients using the method of enzyme-linked immunosorbent assay.
Results:
Based on signs of systemic inflammation and urinary syndrome, initially patients of all groups (n=60) were in the latent phase of chronic obstructive pyelonephritis. After surgical correction pyelonephritis was diagnosed in all children at point 2, the most pronounced was in the control group. Manifestation of dysbiosis in the control group was more often by 20% than in group 2. The examination of the cytokine profile of urine showed an increasing the level of IL-8 (p<0.0001) at 2 points in all groups, the most significant was in the control group (p<0.002). An increasing the level of IL-10 (p<0.0001) was noted at point 2 in all groups, the most significant was in groups 1 and 2 (p<0.003). High values of the inflammation activity index were observed only at point 2 in the children of the control group (p<0.001).
Conclusion:
The using of immunomodulators and probiotics in the comprehensive preoperative preparation of children with obstructive uropathies reduces the risk, severity and duration of postoperative complications.
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