Our experience of operated pediatric ureteropelvic junction obstruction patients
Teymursha Muradi1, Zafer Turkyilmaz1, Ramazan Karabulut1
1Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey.
Insights
Ureteropelvic junction obstruction (UPJO) in children often presents with intrinsic causes when diagnosed prenatally, requiring earlier surgery. Crossing vessels (CV) are more common in older patients with UPJO.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Scintigraphy
Background:
- Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in children, with varied etiologies including extrinsic and intrinsic factors.
- Understanding the characteristics and outcomes of UPJO is crucial for effective surgical management.
Purpose of the Study:
- To present preoperative and postoperative data of pediatric patients who underwent pyeloplasty for UPJO.
- To analyze demographic, clinical, and histopathological findings associated with UPJO.
Main Methods:
- Retrospective analysis of 64 pediatric patients who underwent open pyeloplasty for UPJO.
- Evaluation included demographic data, hydronephrosis, differential renal function (DRF), renal scintigraphy (t½), and histopathology.
- Statistical analysis was performed to identify associations between findings and patient characteristics.
Main Results:
- Male gender and left-sided UPJO were most prevalent; antenatal diagnosis was common (68.8%).
- Muscular hypertrophy was the most frequent pathological finding; crossing vessels (CV) were found in 17.18% of cases.
- CV was associated with older age at operation, left-sided UPJO, and female gender; re-operation was needed in 7.8%.
Conclusions:
- Intrinsic UPJO pathologies are more common in prenatally diagnosed cases, necessitating earlier intervention.
- Crossing vessels are more frequently observed in UPJO patients diagnosed and operated at older ages.
Aims:
Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO.
Methods:
A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients' numerical results were stated as mean ± standard deviation (SD).
Results:
Male gender was more prevalent (n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% (n = 36), and at the right side in 39.1% (n = 25) of patients. It was bilateral in 4.7% (n = 3). Hydronephrosis was found antenatally in 68.8% (n = 44) of patients. The mean preoperative DRF was 49.7% (21-78%) and mean postoperative DRF was 49.2% (20-56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10-62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3-40 mm). Crossing vessel (CV) was detected in 17.18% (n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%).
Conclusions:
Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:22Ureters
01:26Kidney Transplant II: Surgical Procedure
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
01:30Urinary Tract Calculi III: Medical Management