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Management of ureteropelvic obstruction in the first year of life
Insights
Surgical repair of ureteropelvic junction obstruction in infants is effective. Using nephrostomy or pyelostomy drainage with stents aids in preventing infant ureter obstruction, leading to successful outcomes.
Area of Science:
- Pediatric Urology
- Surgical Techniques
Background:
- Ureteropelvic junction (UPJ) obstruction is a common congenital anomaly in infants.
- Early diagnosis and effective surgical management are crucial for preserving renal function.
Purpose of the Study:
- To evaluate the efficacy of dismembered reduction pyeloureteroplasty with adjunctive drainage and stenting in infants with UPJ obstruction.
- To assess the role of renal biopsy in decision-making and prognosis.
Main Methods:
- Retrospective analysis of 24 infants (32 obstructed kidneys) treated between 1971 and 1978.
- Diagnosis via high-dose excretory urography; ultrasound used for hydronephrosis confirmation.
- Surgical repair involved dismembered reduction pyeloureteroplasty, with 20 of 27 repairs utilizing nephrostomy/pyelostomy and stenting.
Main Results:
- 27 successful pyeloureteroplasties were performed.
- Repairs protected by drainage and stenting showed fewer complications.
- No secondary nephrectomies were required; 2 reoperations were successful.
- Renal biopsy aided in repair decisions and prognosis.
Conclusions:
- Nephrostomy/pyelostomy with intubation is a valuable adjunct in infant UPJ obstruction repair.
- This technique helps prevent ureteral obstruction from edema or kinking in delicate infant ureters.
- Surgical intervention, including adjunctive measures, leads to successful outcomes in pediatric UPJ obstruction.
Abstract:
From July 1971 until December 1978 we treated 19 male and 5 female children less than 1 year old for ureteropelvic junction obstruction. Diagnosis was based on high dose excretory urography with delayed films. Ultrasound was performed in some cases to confirm hydronephrosis. Cystoscopy and retrograde pyelography were not required. Of 32 obstructed kidneys 27 were repaired by dismembered reduction pyeloureteroplasty. Of 8 patients with bilateral involvement 3 underwent unilateral repair only because of lesser contralateral obstruction and 1 underwent unilateral nephrectomy. Of the 27 repairs 20 were protected by nephrostomy or pyelostomy drainage plus a small caliber silicone rubber or polyvinyl stent. Of the 6 non-stented repairs 2 had delayed opening of the repair. A frozen section renal biopsy aided in a decision to repair the kidney in 4 of 6 instances and in 10 other instances a renal biopsy was obtained for prognostic purposes. There were no secondary nephrectomies, although 2 boys required reoperations for a successful result. Instillation pyelography with fluoroscopic monitoring was used to determine when the tubes could be removed. Generally, we removed the stent 4 or 5 days postoperatively and the nephrostomy at a variable time after demonstration of patency of repair. In this group of small children pyelostomy or nephrostomy and intubation of the repair are useful additions to the surgical technique to prevent obstruction of the tiny and delicate infant ureter by anastomotic edema or kinking of the repair.