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What is the Critical age for the Improvement of Parenchymal Thickness after Pyeloplasty?
Derya Yayla1, Gokhan Demirtas2, Bilge Karabulut3
1Department of Pediatric Urology, Ministry of Health Ankara City Hospital, Ankara, Turkey. dryayla@yahoo.com.
Insights
Optimal surgical timing for ureteropelvic junction obstruction (UPJO) is crucial. Early pyeloplasty before 38 months improves renal parenchymal recovery, while older patients experience inadequate healing.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Ureteropelvic junction obstruction (UPJO) can lead to irreversible renal damage if not treated promptly.
- Assessing the optimal age for surgical intervention is critical to prevent long-term renal impairment.
Purpose of the Study:
- To investigate the relationship between patient age at pyeloplasty and subsequent renal parenchymal recovery in UPJO cases.
- To identify an age threshold for predicting successful renal recovery after pyeloplasty.
Main Methods:
- Retrospective analysis of 156 patients diagnosed with UPJO who underwent pyeloplasty between 2007 and 2019.
- Evaluation of demographic data, ultrasonography, and renal scintigraphy findings.
Main Results:
- Renal parenchymal recovery after pyeloplasty was significantly associated with younger patient age.
- A cut-off age of 38 months was identified; patients operated on before this age showed better parenchymal recovery.
- Optimal functional improvement was observed in children under 13 months.
Conclusions:
- Pyeloplasty for UPJO should be performed before significant renal damage occurs.
- Postoperative change in renal parenchymal thickness is a key indicator of recovery.
- Advancing age at surgery limits the potential for reversing obstructive nephropathy.
Purpose:
The most important point in cases of ureteropelvic junction obstruction (UPJO) is to decide on the need and timing of surgical treatment. Renal damage may become irreversible as the duration of the obstruction is prolonged. Worsening of hydronephrosis and decrease in renal parenchymal thickness after pyeloplasty may herald an irreversible renal damage. It is important to know at what age this damage begins. In this study, we aimed to determine the relationship between the age of the patients at the time of pyeloplasty performed for UPJO and parenchymal recovery.
Materials And Methods:
In our study, 156 patients (mean age: 43.5 months) who underwent pyeloplasty with the diagnosis of UPJO between 2007 and 2019 were evaluated retrospectively. Demographic characteristics, ultrasonographic (USG) and nuclear renal scintigraphy findings, previous surgeries of the patients were recorded.
Results:
Numerical variables were evaluated statistically, and the best cut-off point was determined. Parenchymal thickening was determined as the most important criterion in postoperative renal recovery which was more evident at early ages. Based on statistical assessments , the cut-off age for renal parenchymal recovery was determined as 38 months. While parenchymal recovery was inadequate after pyeloplasty performed in patients older than 38 months, the most significant improvement in renal functions was seen in children younger than 13 months of age.
Conclusion:
Pyeloplasty should be performed in patients with UPJO before development of severe renal damage. Statistically, the best parameter to evaluate the recovery after pyeloplasty is the change in parenchymal thickness. With advancing age, it is impossible to reverse the obstructive nephropathy.
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