Management of Severe Bilateral Ureteropelvic Junction Obstruction in Neonates with Prenatally Diagnosed Bilateral Hydronephrosis
김종원, 홍성우, 박창후, 박홍주, 김건석,
소속 상세정보
김종원 ( Kim Jong-Won )
울산대학교 의과대학 서울아산병원 비뇨기과학교실
홍성우 ( Hong Sung-Woo )
울산대학교 의과대학 서울아산병원 비뇨기과학교실
박창후 ( Park Chang-Hoo )
울산대학교 의과대학 강릉아산병원 비뇨기과학교실
박홍주 ( Park Hong-Zoo )
강원대학교 의과대학 비뇨기과학교실
김건석 ( Kim Kun-Suk )
울산대학교 의과대학 서울아산병원 비뇨기과학교실
KMID : 0358320100510090653
Abstract
PurposeThe management of prenatally detected bilateral ureteropelvic junction obstruction (UPJO) remains controversial. We attempted to develop a treatment plan for patients with severe bilateral UPJO.
Materials and MethodsWe evaluated the records of 13 patients with prenatally diagnosed grade 3 or more bilateral hydronephrosis that led to the postnatal diagnosis of severe bilateral UPJO. Ultrasonography and 99mtechnetium mercaptoacetyltriglycine (99mTc-MAG3) renal scans were performed within 1 month. Four renal units had grade 3 and 22 had grade 4 hydronephrosis. All 13 patients were managed by unilateral pyeloplasty, and the patients’ mean age was 3 months. At 1 month postoperatively, we decided whether delayed surgery in the opposite renal unit was necessary according to the findings of ultrasonography and 99mTc-MAG3 scans.
ResultsOf 13 patients, 11 underwent initial pyeloplasty on renal units with more severe hydronephrosis or lower relative renal function (RRF) on 99mTc-MAG3 scans. The remaining 2 patients simultaneously underwent percutaneous nephrostomy on renal units with a lower RRF and initial pyeloplasty on renal units with a higher RRF. In 5 patients, contralateral hydronephrosis had spontaneously improved at 1 month postoperatively, and 8 patients underwent delayed contralateral pyeloplasty at 2 months postoperatively.
Conclusions
In children with severe bilateral UPJO, the non-operated renal units with grade 3 and some with grade 4 hydronephrosis improved spontaneously after unilateral pyeloplasty. Therefore, delayed pyeloplasty of the opposite side should be considered at 1 month following initial pyeloplasty.
키워드
Hydronephrosis;Ultrasonography;Ureteral obstruction
원문 및 링크아웃 정보
등재저널 정보