以腎盂與輸尿管重接手術治療無症狀先天性腎盂與輸尿管交接處狹窄的結果分析
鄭鴻琳* 邱元佑
國立成功大學醫學院暨附設醫院泌尿部* 小兒科部
Clinical outcome of dismembered pyeloplasty in the treatment of non-symptomatic ureteropelvic junction obstruction
Hong-Lin Cheng* Yuan-Yow Chiou
Departments of Urology*and Pediatrics, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan
Purpose: Congenital ureteropelvic junction (UPJ) obstruction is not a common disease, the incidence estimated about one in 1500 live birth. For the popular use of prenatal ultrasound screening, 0.2% to 2 % of fetus with hydronephrosis was detected and postnatal renal abnormality was related to the severity in utero. Delayed surgery was the current strategy in the management of UPJ obstruction. Herein, we reported our results following this principle.
Materials and Methods: A total of 80 patients with bilateral involvement in 7 patients were enrolled in this retrospected study. Of the 95 procedures, 8 underwent re-do surgery including twice in one renal unit. All the hydronephrosis were detected by prenatal or postnatal ultrasound and then followed up with diuretic renal scan and voiding cystourthrography in addition to ultrasound. Surgical indications were progressive grade IV hydronephrosis combined with renal function deterioration. The age of operation was from 7 days to 9 years and 8 months (median 2 months). Follow-up period was at least 3 months after surgery.
Results: Of the 58 renal units, 3 (5.2%) improved to grade 0 in the severity of hydronephrosis, 20 (34.5%) to grade I, 15 (25.9%) to grade II, and 12 (20.7%) to grade III along with 8 (13.8%) staying in grade IV. Of the 71 unilateral patients with initial renal function evaluation, 41 (57.7%) were in the good function group (>=40%), 24 (33.8%) in the moderate function group (20%-40%), and 6 (8.5%) in the poor function group (<20%). After surgery with renal function evaluation in 62 unilateral patients, 39 (62.9%) were in the good function group, 18 (29.0%) in the moderate function group, and 5 (8.1%) in the poor function group.
Conclusions: In our series, most of the patient with non-symptomatic UPJ obstruction will achieve apparent improvement in morphology and keep renal function stabilized following the strategy of delayed surgery.