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Pelvic hydronephrosis in children: a review of 219 personal cases
Insights
Hydronephrosis in children is more common in males and on the left side, often presenting as an abdominal mass. Surgical reconstruction, primarily dismembered pyeloureteroplasty, yielded satisfactory long-term results for pediatric hydronephrosis.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Pediatrics
Background:
- Hydronephrosis, characterized by kidney swelling, affects children and can present with varied symptoms.
- The condition is more prevalent in males and on the left side, with bilateral cases common in infants.
- Presentation ranges from asymptomatic cases to abdominal masses or pain, and occasionally trauma-related rupture.
Purpose of the Study:
- To report on a series of pediatric hydronephrosis cases.
- To analyze the clinical presentation, management, and outcomes of hydronephrosis in children.
- To evaluate the efficacy of surgical reconstruction for pediatric hydronephrosis.
Main Methods:
- Retrospective review of 238 hydronephrotic kidneys in 219 children.
- Analysis of presenting features, including age, sex, laterality, and symptoms.
- Surgical management strategies, including pyeloplasty, nephrostomy, and nephrectomy, were documented.
Main Results:
- Hydronephrosis was more common in males and on the left side; bilateral cases were frequent in infants.
- Abdominal mass was the commonest feature in infants, while pain predominated in older children.
- Dismembered pyeloureteroplasty was the preferred reconstruction; nephrectomy was performed in 10% of cases with satisfactory late outcomes.
Conclusions:
- Pediatric hydronephrosis management via reconstructive surgery, particularly pyeloureteroplasty, leads to favorable long-term results.
- Even kidneys with initially doubtful prognosis can show significant improvement after surgical intervention.
- Reconstructive surgery for pediatric hydronephrosis is effective, with low rates of reoperation and no secondary nephrectomies.
Abstract:
A series of 238 hydronephrotic kidneys in 219 children is reported. The condition was more common in the male than in the female subject and occurred more frequently on the left side. It was often bilateral, especially in infants, with an abdominal mass as the common presenting feature. Loin or abdominal pain was the most frequent complaint in older children. In some cases hydronephrosis presented as a ruptured kidney following trauma. Only 1 patient was hypertensive. The lesion was asymptomatic in 18 cases and the incidence of urinary infection was low. Dismembered pyeloureteroplasty was the procedure of choice for reconstruction. Preliminary nephrostomy was used rarely and nephrectomy was done in 10 per cent of the kidneys. Of the 7 reoperations 4 were for persistent obstruction and 3 were because stones had formed after the pyeloplasty. The late results, assessed clinically and radiologically, have been entirely satisfactory. Many kidneys of initially doubtful value showed useful improvement after reconstructive operation and no secondary nephrectomies were performed. The only death in the series occurred 2 1/2 years postoperatively and was unrelated to the urinary tract.