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Pelviureteric obstruction in children
Insights
Treatment for pediatric hydronephrosis has shifted from nephrectomy to dismembered pyeloplasty, yielding better outcomes. This surgical approach, particularly the Anderson-Hynes technique, is key for successful hydronephrotic kidney management in children.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Techniques
Background:
- Hydronephrosis affects children, with left kidneys and males more commonly impacted.
- Presentation varies by age, including abdominal mass in infants and pain/hematuria in older children.
Purpose of the Study:
- To analyze treatment trends and outcomes for pediatric hydronephrosis over 30 years.
- To evaluate the efficacy of different surgical interventions for hydronephrosis.
Main Methods:
- Retrospective review of 161 hydronephrotic kidneys in 147 children over 30 years.
- Comparison of nephrectomy versus dismembered pyeloplasty (Anderson-Hynes technique and modifications).
Main Results:
- A significant shift from nephrectomy to dismembered pyeloplasty was observed.
- Dismembered pyeloplasties demonstrated good to excellent results, superior to non-dismembered techniques.
- Mortality was low (2 cases), associated with preoperative uremia.
Conclusions:
- Dismembered pyeloplasty, especially the Anderson-Hynes technique, is the preferred treatment for pediatric hydronephrosis.
- Optimal outcomes require meticulous surgical technique, postoperative nephrostomy drainage, stenting, and pyelonephritis control.
Abstract:
A series of 161 hydronephrotic kidneys from a 30-year period in 147 children is reported. The left kidney was affected more frequently than the right and the condition was more common in the male than in the female child. In infants, abdominal mass was a common mode of presentation. In older children, loin or abdominal pain, haematuria and urinary tract infection were typical findings. The principles of treatment have changed: during 3 decades there has been a definite shift from nephrectomy to dismembered pyeloplasty, mostly according to Anderson-Hynes technique or its modifications. The results of the dismembered pyeloplasties were good or excellent as contrasted with often unsatisfactory results of the non-dismembered pyeloplasties. There were 1 early and 1 late death in the series; both of these patients were uraemic already preoperatively. The key to good results is the dismembered pyeloplasty with postoperative nephrostomy drainage and applying a stent for the anastomosis, combined with strict control of postoperative pyelonephritis.