Does Early Detection of Ureteropelvic Junction Obstruction Improve Surgical Outcome in Terms of Renal Function?

Chertin, Boris; Fridmans, Alon; Knizhnik, Michael; Hadas-Shalperin, I.; Hain, Daniel; Farkas, Amicur

doi:10.1016/s0022-5347(01)68058-3

Cited by 88 publications

(28 citation statements)

References 15 publications

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“…Chertin et al . [4] reviewed 113 paediatric patients who underwent dismembered pyeloplasty. Fifty were followed closely and ultimately received pyeloplasty at 11 months, while the other 63 were lost to follow‐up and were treated at 5 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…Some technetium‐99m MAG3 (99mTc‐MAG3) renographic studies have suggested that RRF does not improve after pyeloplasty [2,3]. Others studies have suggested that RRF improves after pyeloplasty, but that this is dependent upon procedural timing [4,5] and preoperative RRF [5,6]. In adults, studies examining relatively small populations have found that RRF did not improve in patients after surgery, but that RRF in patients with higher preoperative RRF was more likely to improve [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Relative renal function does not improve after relieving chronic renal obstruction

Wu¹,

Tran²,

Sorensen³

et al. 2012

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Technetium‐99m MAG3 renography can be used to quantify relative renal function (RRF). Deterioration of renal function occurs with chronic obstruction. Small studies have previously shown that RRF is not improved in adult patients after pyeloplasty. Some studies have suggested that patients with higher preoperative RRF are more likely to improve. To our knowledge, these data represent the largest review of cases related to this subject. This study verifies past studies' assertions that RRF does not improve after relief of chronic renal obstruction. Using multivariable analysis, we identify lower age and lower preoperative RRF as predictors of >7% improvement in RRF. These data suggest that the aim of relieving obstruction should be to maintain RRF and alleviate symptoms, but not to seek improvement in overall renal function. OBJECTIVE To determine the change in relative renal function (RRF) after relief of chronic obstruction in adults. PATIENTS AND METHODS We retrospectively identified 85 adult patients who underwent scintigraphic diuretic renography before and after an intervention to relieve chronic unilateral renal obstruction. Patients were stratified into groups of low (<20%), medium (20‐40%) and high (>40%) preoperative RRF in the obstructed kidney. Each group was assessed for change in RRF after relief of obstruction. We performed multivariable logistic regression analysis to determine whether age and pre‐procedural RRF predicted a >7% improvement in RRF, controlling for medical comorbidities and type of obstruction. RESULTS The mean (sd) patient age was 43.6 (16.8) years and 66% of patients were female. The mean (sd) pre‐ and postoperative RRF values were not significantly different (37.6 [12.3] % vs 38.4 [13.6] %; P = 0.31). Patients stratified by low, medium and high preoperative function showed no significant change in postoperative RRF (P = 0.53, 0.39 and 0.77, respectively). In multivariable logistic regression analysis, younger age (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.83–0.98) and lower preoperative RRF (OR 0.90, 95% CI 0.83–0.97) predicted improvement in RRF of >7%, after adjustment. CONCLUSIONS RRF does not significantly increase after relief of chronic obstruction. The goals of relieving chronic renal obstruction should be to maintain renal function and relieve symptoms, but not to regain renal function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relative renal function does not improve after relieving chronic renal obstruction

Wu¹,

Tran²,

Sorensen³

et al. 2012

BJU International

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“…Our regimen of conservative follow-up was published elsewhere. 1,2,14 Ultrasonography was performed on day 3 of life in those children with an antenatal diagnosis of hydronephrosis, with the examination repeated to grade hydronephrosis and radionuclide studies undertaken at 6 to 8 weeks of age. Voiding cystourethrography (VCUG) was performed to exclude vesicoureteral reflux (VUR).…”

Section: Methodsmentioning

confidence: 99%

“…The majority of the children with antenatally diagnosed hydronephrosis, which led to postnatal diagnosis of the ureterovesical junction (UVJ) obstruction, do not require surgical intervention and improve renal function over the period of conservative follow-up. [1][2][3][4][5][6] The percentage of children in need of surgery ranges from 23 to 30% in various articles in the literature. [7][8][9][10] We have previously published that risk factors, which might require surgical correction were Society for Fetal Urology (SFU) grades 3 and 4 of postnatal hydronephrosis, relative renal function less than 30%, and ureteral diameter more than 1.33 cm.…”

Section: Introductionmentioning

confidence: 99%

Does Renal Function Remain Stable after Puberty in Children who underwent Ureteral Reimplantation due to Ureterovesical Junction Obstruction?

et al. 2020

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Introduction Ureteric reimplantation due to ureterovesical junction (UVJ) obstruction enjoys high success in the short term. However, renal function after reimplantation must accommodate the numerous changes in the pediatric urinary tract that occur along with child development that may theoretically cause an occult loss of renal function. The purpose of this study was to evaluate whether improved renal function after ureter reimplantation for antenatal diagnosed UVJ obstruction remains stable after puberty. Materials and Methods Twenty-one children who underwent open reimplantation using Politano–Leadbetter technique were followed until they completed puberty. Mean age at surgery was 14.3 months (range: 3–60 months). Five (23.8%) of 21 children had right hydronephrosis, 13 (61.9%) had left hydronephrosis, and 3 (14.3%) had bilateral hydronephrosis. The Society for Fetal Urology (SFU) level of the hydronephrosis was 3 (47.6%) in 10 children and 4 (52.4%) in remaining 11. Fourteen (66.6%) patients had poor renal function upon surgery and the remaining seven (33.4%) patients had moderate renal function. The mean renal function upon operation was 28 ± 4.3 (mean ± standard deviation [SD]). Results Reimplantation led to the increase in the RRF in the short-term period from 28 ± 4.3% prior to the surgery to 36.4 ± 5% (p < 0.001) in all patients and remains stable 35 ± 5% after puberty in all the reviewed patients. Conclusion Our data demonstrate for the first time that successful ureteral reimplantation following antenatal diagnosis of UVJ obstruction is associated with an improvement in renal function, not only during short- and midterm follow-up but also allows preserving the renal function throughout the puberty period.

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“…Es existieren longitudinale Follow-up-Studien über pränatale und neonatale Hydronephrosen[9,20,23,26], die jedoch in Bezug auf die optimale Behandlung keine übereinstimmenden Ergebnisse zeigen. Diese prospektiven Studien werden ausgeglichen durch eine Anzahl retrospektiver Studien, die darüber berichten, dass ein konservatives Vorgehen mit einem höheren Risiko des Verlustes der Funktion der hydronephrotischen Niere einhergeht[5,6,8,18,24].SchlussfolgerungDie Renographie stellt eine ¹state-of-the-artª-Methode zur Diagnostik der Nierenfunktion dar. Sie ist die Methode der Wahl, um die seitengetrennte Nierenfunktion genau zu beurteilen, die wiederum ein wichtiger Parameter in der Diagnostik der pränatal entdeckten Hydronephrose ist.…”

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Zur klinischen Wertigkeit der Nierenfunktionsszintigraphie bei pränatal diagnostizierten renalen Abflussstörungen

2003

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Does Early Detection of Ureteropelvic Junction Obstruction Improve Surgical Outcome in Terms of Renal Function?

Cited by 88 publications

References 15 publications

Relative renal function does not improve after relieving chronic renal obstruction

Relative renal function does not improve after relieving chronic renal obstruction

Does Renal Function Remain Stable after Puberty in Children who underwent Ureteral Reimplantation due to Ureterovesical Junction Obstruction?

Zur klinischen Wertigkeit der Nierenfunktionsszintigraphie bei pränatal diagnostizierten renalen Abflussstörungen

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