Conservative Treatment of Ureteropelvic Junction Obstruction in Children with Antenatal Diagnosis of Hydronephrosis: Lessons Learned after 16 Years of Follow-Up

Chertin, Boris; Pollack, Avner; Koulikov, Dmitry; Rabinowitz, Ron; Hain, Daniel; Hadas-Halpren, Irit; Farkas, Amicur

doi:10.1016/j.eururo.2006.01.046

Cited by 227 publications

(146 citation statements)

References 19 publications

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“…UPJO is common in children, for which Anderson-Hynes pyeloplasty is the classic surgical treatment [5,6] < B1 B2 > < /C< B3 B4 > <, and there have been some reports concerning about UTI in patients with UPJO [1,2]. Unlike previous studies, in the present study, urine taken directly from the renal pelvis was cultured.…”

Section: Discussionmentioning

confidence: 39%

“…Our study found that there was no significant relationship between age or gender and bacteriuria or funguria, perhaps because boys were more likely develop UPJO, [5,6] whereas girls were much more likely to develop a UTI after 1 year [9]. Increasingly, UPJO is discovered by prenatal ultrasound [6], but being diagnosed by prenatal ultrasound was not a risk factor to develop bacteriuria or funguria. In addition, hydronephrosis [5], abdominal pain, hematuria, and mass were not risk factors.…”

Section: Discussionmentioning

confidence: 60%

“…No previous study has reported a relationship between parenchymal thickness and bacteriuria or funguria. We found that parenchymal thickness was not a risk factor, although, deterioration in renal function was associated with exacerbation of hydronephrosis and decrease in parenchymal thickness in some patients [5,6]. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.…”

Section: Discussionmentioning

confidence: 87%

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Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Deng¹,

Zhang²,

Li³

et al. 2011

OJU

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Objective: To detect bacteriuria or funguria by urine culture taken from the renal pelvis directly before Anderson-Hynes pyeloplasty. Methods: 290 patients who underwent Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction (UPJO) were included in a retrospective analysis. Urine was obtained directly before the renal pelvis was opened, and was carried to the laboratory for bacterial culture. Clinical features were analyzed to evaluate risk factors for bacteriuria or funguria by comparing patients whose urine yielded positive cultures to those whose urine cultures were negative for bacteria or yeast. Results: Eighteen patients (6.2%) had positive urine cultures, including six cultures positive for Escherichia coli (E. coli), four for Pseudomonas aeruginosa, three for klebsiella pneumoniae, one for maltophilia monad, one for Enterococcus faecium, one for Candida albicans, one for Candida parapsilosis, and one for yeast not otherwise specified. Bacteriuria or funguria was significantly correlated with four clinical features: fever, urinary urgency, and history of nephrostomy or pyeloplasty. Conclusions: Bacteriuria or funguria was less common in children with UPJO, and the majority of organisms were identified as Escherichia coli, Pseudomonas aeruginosa, or Klebsiella pneumoniae. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.

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Section: Discussionmentioning

confidence: 39%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 87%

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Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Deng¹,

Zhang²,

Li³

et al. 2011

OJU

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“…Obstructive hydronephrosis is usually diagnosed by imaging prolonged drainage in diuretic renal scintigraphy [20]. The renogram pattern identified in diuretic scintigraphy is related to the degree of the obstruction and it helps to decide whether a surgical treatment is needed or not [21][22][23][24]; because, in UPJO treatment, there are two debatable facts; first the initial management of patients and second the appropriate time of surgical intervention. In dynamic renal scintigraphy, the first finding in hydronephrotic kidneys is the decrease of radiotracer in similar amounts in renal pelvis and collecting system in the area surrounding renal parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different periods of renal cortical activity ratios in the evaluation of ureteropelvic junction obstruction by dynamic renal scintigraphy

Hasbek¹,

Özdemir²,

Turgut³

et al. 2014

Cumhuriyet Med J

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Aim. The aim of this retrospective study is to investigate whether the renal cortical activity at 1st and 20th minutes in renal scintigraphy can be used as a following parameter to determine the presence of obstruction in pediatric patients group with ureteropelvic junction obstruction. Method. The consecutive 322 kidney renograms were included in the study. Standardized diuretic renograms were visually classified into three groups as non-obstructive, obstructive and indetermined according to their responses to the diuretic. In addition, the cortical regions of interest (ROI) were drawn manually at 1st and 20th min for each kidney and the cortical counts were obtained. Apart from this, kidneys were divided into three major sub-groups based on clearance half-time (T1/2); T1/2<10 min was defined as non-obstruction, T1/2>20 min as obstruction and T1/2 with a value between 10 and 20 minutes as an indeterminate result. Afterwards visual obstruction patterns and 1st/20th min. cortical activity ratios were compared. Results. When the cortical activity ratios are compared to visual obstructive pattern(nonobstructive, obstructive and indeterminate); on the Tc99m DTPA renograms the cortical activity ratios which were greater than 82.8% were obstructive, ranging from 59.3% to 82.8% were found indeterminate. On the Tc-99m MAG-3 renograms the cortical activity ratios which were greater than 74.2% were obstructive, ranging from 44.6% to74.2% were found indeterminate. As a result of the comparison of T 1/2 parameter with the obstruction patterns of the kidneys, T1/2 was in indeterminate group in 124 (41.5%) out of 299 kidneys visually evaluated as non-obstructive while in 7 (2.3%) kidneys T1/2 was in obstructive group. In 4 (23.5%) out of 17 kidneys which were visually evaluated as indeterminate, T 1/2 was in normal group, in 5 (29.4%) of them T 1/2 was in indeterminate group and in 8 (47.1%) of the 17 kidneys T1/2 was in obstructive group. Conclusion. We think that the use of 1st/20th min. cortical activity ratios on the diuretic renogram are helpful in establishing a diagnosis of obstruction in pediatric patient group.

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“…Conservative management of these patients is often recommended, with surgery reserved for patients with clinical symptoms or declining renal function. However, over time up to 50% of patients with unilateral UPJ obstruction will meet these criteria and require surgical correction (Chertin et al, 2006). Additionally, some authors have raised concern about an increased long-term risk for hypertension as a result of ureteral obstruction, advocating for reconsideration of these conservative management approaches (Carlstrom, 2010).…”

Section: Management Of Congenital Upper Urinary Tract Obstructionmentioning

confidence: 99%

Congenital Obstructive Nephropathy: Clinical Perspectives and Animal Models

Ingraham¹,

McHugh²

2012

Novel Insights on Chronic Kidney Disease, Acute Kidney Injury and Polycystic Kidney Disease

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Conservative Treatment of Ureteropelvic Junction Obstruction in Children with Antenatal Diagnosis of Hydronephrosis: Lessons Learned after 16 Years of Follow-Up

Cited by 227 publications

References 19 publications

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Comparison of two different periods of renal cortical activity ratios in the evaluation of ureteropelvic junction obstruction by dynamic renal scintigraphy

Congenital Obstructive Nephropathy: Clinical Perspectives and Animal Models

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