Risk factors for recurrenсe of hydronephrosis in children

Abstract

Introduction. Relapse after radical correction of congenital hydronephrosis (CH) in children occurs in 5–11% of cases. However, the predictors of repeated obstruction of the pyeloureteral segment (PUS) have not yet been sufficiently evaluated, which determines the relevance of the topic. Aim: to detect the risk factors for recurrence of hydronephrosis in children to develop methods for its prevention. Materials and methods. There were examined one hundred children with hydronephrosis divided into 2 groups. Group 1 consisted of 50 patients with recurrent hydronephrosis (RH), group 2 (control) — 50 children without RH with a comparable functional condition of the affected kidney. The analysis of the influence of pre-, intra- and postoperative parameters on the outcome of the primary intervention was carried out. Results. During primary intervention in CH patients from group 1, we identified the following significant differences compared with patients of group 2: the use of non-resection pyeloplasty; a more extended stricture of the PUS; an indentation of less than 5 mm from the edge of stenosis; tension of the edges of the anastomosis due to insufficient mobilization; acute pyelonephritis during the early postoperative period. When the anastomosis tissues were stretched, only one type of urine drainage (internal or external) was performed in patients from group 1, and combined drainage was provided in patients of group 2. Conclusion. To prevent recurrence of hydronephrosis in children, it is necessary to perform exclusively resection ureteropyeloplasty with adequate tissue mobilization and a wide margin from the edge of stenosis, use combined drainage when stretching the edges of the anastomosis and ensure the observation of operated children before moving to the adult network.