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The effect of ureteropelvic junction obstruction and pyeloplasty on somatic growth during infancy
Eyal Kord1, Binyamin B Neeman2, Dolev Perez2
1Department of Urology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, P.O. Box 70300, Zerifin, Israel.
Insights
Perinatal ureteropelvic junction obstruction (UPJO) may increase infant growth restriction risk. Pyeloplasty surgery in infancy does not negatively impact growth, and height may improve in restricted infants.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Growth and Development
Background:
- Limited evidence exists on the impact of perinatal ureteropelvic junction obstruction (UPJO) and its surgical correction on infant somatic growth.
- Understanding these effects is crucial for parental counseling and informed treatment decisions.
Purpose of the Study:
- To evaluate the impact of unilateral UPJO and subsequent surgical correction on somatic growth in infants diagnosed antenatally.
- To assess growth parameters in infants treated for UPJO during infancy.
Main Methods:
- Retrospective analysis of 48 infants under 2 years old treated with dismembered pyeloplasty for UPJO.
- Somatic growth (height and weight) was measured at 1 month, time of surgery, and 6 months post-surgery.
- Standard deviation scores (SDSs) for height and weight were calculated and compared.
Main Results:
- No significant difference in somatic growth (SDS for height and weight) was observed related to measurement time or surgical intervention in the overall cohort.
- 22.9% of infants showed growth restriction (SDS < -1), and 6.3% (3/48) had severe restriction (SDS < -2).
- Infants with growth restriction demonstrated significant linear height improvement both before and after pyeloplasty.
Conclusions:
- Antenatally diagnosed unilateral UPJO as an isolated anomaly may be associated with an increased risk of somatic growth restriction.
- Pyeloplasty during infancy does not appear to negatively affect somatic growth.
- Height improvement is noted in growth-restricted infants, irrespective of surgical timing, aiding parental counseling.
Background:
Evidence regarding the impact of perinatal ureteropelvic junction obstruction (UPJO) and surgical correction during infancy, on somatic growth are scarce. Understanding these impacts could help advise parents and aid in treatment decision making.
Objectives:
To assess the impact of unilateral UPJO and surgical correction on somatic growth in infants diagnosed antenatally and treated during infancy.
Design:
A retrospective bi-institutional analysis of somatic growth in patients under 2 years who underwent dismembered pyeloplasty for the treatment of UPJO was conducted.
Methods:
We evaluated patients who were diagnosed with unilateral hydronephrosis during pre-natal ultrasound screening for detection of fetal anomalies between May 2015 and October 2020. The height and weight of patients who were diagnosed with UPJO were recorded at the age of 1 month, time of surgery, and 6 months after surgery. Standard deviation scores (SDSs) for height and weight were calculated and compared.
Results:
Forty-eight patients under the age of 2 years were included in the analysis. Median age and weight at pyeloplasty were 6.9 months and 7.5 kg. At 1 month, the median SDS for weight in the entire cohort was -0.30 [interquartile range (IQR): -1.0 to 0.63] and the median SDS for height was -0.26 (IQR: -1.08 to 0.52). In 22.9% of patients (11/48), weight and height were below -1 age-appropriate standard deviations, and 6.3% (3/48) were below -2 standard deviations, suggesting growth restriction. When comparing SDS for the entire cohort, there was no significant difference corelated to measurement time or effect of surgery. In the growth restricted cohort, we found a significant improvement in linear growth for height, which was demonstrated between birth and surgery as well as after surgery.
Conclusion:
Infants with unilateral UPJO diagnosed antenatally as a single anomaly may be at an increased risk of somatic growth restriction in comparison with the general population. In children with growth restriction at time of birth, height seems to improve regardless of surgical treatment. Pyeloplasty during infancy does not seem to negatively affect somatic growth. These findings can be used to counsel parents regarding the potential effects of UPJO and pyeloplasty.
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