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[Bilateral obstructive diseases of the upper urinary tract in children]
Insights
This study reviews surgical and conservative treatments for obstructive urinary tract diseases in 371 children. Surgical interventions like uretero-pelvic anastomosis were performed for bilateral hydronephrosis and obstructive megaureter.
Area of Science:
- Pediatric Urology
- Surgical Management of Congenital Anomalies
Background:
- Obstructive diseases of the urinary tract are a significant concern in pediatric populations.
- Bilateral hydronephrosis and bilateral obstructive megaureter represent common and challenging conditions.
Observation:
- The study analyzed 371 children aged 4 days to 15 years with these conditions.
- Specific focus was placed on bilateral hydronephrosis (51 cases) and bilateral obstructive megaureter (54 cases).
Findings:
- A novel uretero-pelvic anastomosis was successfully performed in 47 children with bilateral hydronephrosis, with 31 undergoing staged procedures.
- Pelvic resection was conducted in 5 cases.
- Surgical treatment was applied to 46 patients (92 ureters) with obstructive megaureter, while 8 were managed conservatively.
Implications:
- Stepwise operative treatment principles and indications for non-drainage plasty in hydronephrosis are detailed.
- Conservative management is deemed appropriate for obstructive megaureter with compensated urodynamics and regular radiological-urodynamic monitoring.
- Ureterocystoneostomy is reserved for progressive obstructive megaureter cases.
Abstract:
The authors examined 371 children aged 4 days to 15 years with obstructive diseases of the urinary tract. In 51 out of them there was bilateral hydronephrosis and 54 had bilateral obstructive megaureter. A new uretero-pelvic anastomosis was made in 47 children with bilateral hydronephrosis, in 31 out of them it was created successively. Resection of the pelvis was performed in 5 cases. Principles of the stepwise operative treatment are described as well as indications to a plasty without drainage in hydronephrosis. Operations were performed on 46 patients (92 ureters) with obstructive megaureter, 8 patients were treated conservatively. The conservative treatment is thought by the authors to be expedient in patients with compensated disturbance of urodynamics of the upper urinary tracts in obstructive megaureter and the every year rentgen-urodynamic control. Ureterocystoneostomy is indicated only in a progressing course of the disease.