Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: Early sonographic changes that correlate with a loss of differential renal function
정두용, 홍창희, 임영재, 이용승, 김상운, 한상원,
소속 상세정보
정두용 ( Chung Doo-Yong )
Yonsei University College of Medicine Department of Urology
홍창희 ( Hong Chang-Hee )
Yonsei University College of Medicine Department of Urology
임영재 ( Im Young-Jae )
Yonsei University College of Medicine Department of Urology
이용승 ( Lee Yong-Seung )
Yonsei University College of Medicine Department of Urology
김상운 ( Kim Sang-Woon )
Yonsei University College of Medicine Department of Urology
한상원 ( Han Sang-Won )
Yonsei University College of Medicine Department of Urology
KMID : 0358320150560020157
Abstract
Purpose: To evaluate changes in differential renal function (DRF), as a functional outcome, in children who underwent redo pyeloplasty for management of failed pyeloplasty and to examine the factors that affect functional outcomes.
Materials and Methods: Between January 2002 and November 2010, a total of 18 patients who underwent redo pyeloplasty for persistent ureteropelvic junction obstruction after failed pyeloplasty were enrolled in this study. We assessed perioperative factors and evaluated changes in renal cortical thickness (RCT), renal function, and hydronephrosis by use of serial ultrasound and diuretic renography.
Results: The mean follow-up period was 44.83±28.86 months. After redo pyeloplasty, prevention of further functional deterioration was observed in only 12 of the 18 patients. After dividing the patients according to this observation, we discovered significant differences in both change in DRF (dDRF) and change in RCT (dRCT) (difference between before and after initial pyeloplasty) between the two groups (p<0.001). Additionally, we noted a significant positive correlation between dRCT and dDRF. All patients showed improvements in hydronephrosis grade and relief of symptoms compared with before redo pyeloplasty.
Conclusions: Redo pyeloplasty should be considered in cases of failed pyeloplasty to preserve renal function and obtain relief from symptoms. If patients show severe deterioration of DRF or a decrease in RCT after initial pyeloplasty, preservation of DRF in these patients after redo pyeloplasty could be difficult. Therefore, redo pyeloplasty should be performed before severe deterioration of DRF or decrease in RCT.
키워드
Hydronephrosis; Radioisotope renography; Treatment failure
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