Outcome analysis of early surgery and conservative treatment in neonates and infants with severe hydronephrosis

Abstract

Objective The treatment strategy and timing of ureteropelvic junction obstruction (UPJO) in infants remain controversial. This study aimed to compare the effect of early surgical treatment (EST) and conservative treatment (CT) on neonates and infants with UPJO and their recovery of renal function and morphology. Methods Eighty neonates and infants with severe hydronephrosis were enrolled in this study. They received early pyeloureteroplasty or CT. Diethylenetriamine pentaacetate was used to assess renal function. Results There were no significant differences in renal function or renal indices at baseline between the two groups. At 3 and 6 months of follow-up, the anteroposterior diameter of the renal pelvis and the Society of Fetal Urology grade in the EST surgery group were significantly lower compared with those at baseline. The thickness of the renal cortex was greater in the EST group than in the CT group at 3 and 6 months of follow-up. After follow-up for 6 months, renal function in the EST group was significantly better than that in the CT group. Conclusion EST accelerates the recovery of renal morphological and functional indices in neonates and infants with severe hydronephrosis.

Laparoscopic pyeloplasty for newborns with severe hydronephrosis

“…Therefore, surgery is the preferred method for treating severe hydronephrosis. Studies by Deng et al (9) reported that during the diagnosis and treatment of severe hydronephrosis, EST can promote the recovery of renal structure and function, and CT may cause worsening of renal functions. In 2014, Policiano et al (10) reported that an APD of over 10 mm in the prenatal US is an indication of surgical intervention.…”

Factors Influencing Postoperative Outcomes in Children with Ureteropelvic Junction Obstruction: A Logistic Regression Analysis

“…Hydronephrosis induces distension of the renal pelvis and calyces, resulting in elevated intrarenal pressure. This pressure effect leads to cortical thinning, deformation of renal medulla blood vessels, activation of relevant inflammatory factors, and progressive renal parenchymal shrinkage, culminating in fibrosis [22,23]. Moreover, a prolonged duration of kidney exposure to hydronephrosis intensifies the degree of compression, resulting in worsened kidney morphology and function, ultimately leading to a poorer postoperative recovery outcome [23,24].…”

“…This pressure effect leads to cortical thinning, deformation of renal medulla blood vessels, activation of relevant inflammatory factors, and progressive renal parenchymal shrinkage, culminating in fibrosis [22,23]. Moreover, a prolonged duration of kidney exposure to hydronephrosis intensifies the degree of compression, resulting in worsened kidney morphology and function, ultimately leading to a poorer postoperative recovery outcome [23,24]. Supporting evidence from animal experiments underscores this pathological transformation, affirming that the recovery after the resolution of urinary tract obstruction in mice depends on both the duration and severity of the obstruction [25].…”

Pilot Study on the Molecular Pathogenesis of Pyeloureteral Junction Obstruction: Underdevelopment or Fibrosis?

“…Ureteral obstruction is a very serious clinical condition, leading to the damage of renal parenchyma because of obstruction-induced increased pressure, reduced glomerular filtration, activation of profibrotic factors, cell apoptosis, and subsequent loss of kidney function, which has been investigated in animal models in a series of studies [1,2]. Early recognition of obstruction, followed by timely treatment, usually results in the recovery of a kidney, mainly because of the better reproduction potential of renal stem cells and the recovery of parenchyma at an early age [3].…”