Ureteropelvic junction obstruction in newborns and infants
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Pediatric ureteropelvic junction obstruction can present as an abdominal mass. Early surgical repair, particularly dismembered pyeloplasty, leads to excellent renal function and shorter hospital stays in infants.
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Ureteropelvic junction obstruction (UJO) is a common cause of congenital hydronephrosis in infants.
- Abdominal masses in infants can be indicative of underlying urinary tract abnormalities, including UJO.
- Diagnostic imaging in neonates and infants presents unique challenges due to physiological factors.
Purpose of the Study:
- To evaluate the diagnostic approach for infants presenting with abdominal masses potentially related to UJO.
- To assess the efficacy and outcomes of nonintubated, nonstented dismembered pyeloplasty in this pediatric population.
- To compare outcomes of primary repair versus temporary nephrostomy diversion.
Main Methods:
- Retrospective review of 11 infants under 1 year old diagnosed with UJO.
- Evaluation of diagnostic imaging modalities including sonography and isotope renal scan.
- Surgical repair techniques assessed: dismembered pyeloplasty (nonintubated, nonstented) and temporary nephrostomy.
Main Results:
- Nine of 11 patients presented with an abdominal mass.
- Successful primary repair using dismembered pyeloplasty in 10 of 13 kidneys with an average postoperative hospital stay of 4.8 days.
- Temporary nephrostomy diversion in 3 kidneys resulted in a longer average hospital stay (15 days) and one complication requiring secondary repair.
Conclusions:
- Sonography followed by isotope renal scan is recommended for evaluating abdominal masses in infants suspected of UJO.
- Nonintubated, nonstented dismembered pyeloplasty is a safe and effective surgical approach for pediatric UJO.
- Early surgical intervention for UJO in infants is associated with excellent renal function and favorable outcomes.
Abstract:
Of 11 patients less than 1 year old with ureteropelvic junction obstruction 9 presented with an abdominal mass. The ideal method evaluation of such patients with an abdominal mass includes sonography followed by isotope renal scan if the mass is determined to be urinary in origin. Visualization by excretory urography in this age group is often impaired by poor renal concentrating ability and excessive bowel gas. Repair was achieved successfully using a nonintubated, nonstented, dismembered pyeloplasty in 10 of 13 kidneys. The average postoperative hospital stay for this group was 4.8 days. Three kidneys were diverted temporarily by nephrostomy, leading to a complication in 1 that required secondary repair. Average postoperative hospital stay in the diverted group was 15 days. Renal function was excellent following repair in all patients, suggesting that early repair is highly desirable in this age group.