Dapeng Jiang1, Bingqiang Tang1, Maosheng Xu1, Houwei Lin1, Longhu Jin1, Lei He1, Guofeng Xu1, Xiaoliang Fang1, Hongquan Geng2. 1. Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: ghongquan@hotmail.com.
Abstract
OBJECTIVE: To evaluate changes in functional and morphological outcomes in children with prenatally diagnosed Society of Fetal Urology (SFU) grades 3-4 ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty at different ages. We also examined the effect of surgical wait time on recovery of renal function. MATERIALS AND METHODS: All patients (aged 0-12 months) with prenatally diagnosed SFU grades 3-4 UPJO who underwent pyeloplasty in a single center between January 2013 and December 2015 were reviewed. One hundred thirty-three children were enrolled in this study. The children were divided into 2 groups according to their age at the time of surgery (group I: 0-3 months, group II: 3-12 months). We evaluated changes in parenchymal thickness, anteroposterior diameter (APD), and differential renal function (DRF) using ultrasound and diuretic renography. Functional and morphological outcomes were compared using Student t test. RESULTS: A total of 133 patients were included in the study. We found a significant difference in the change of DRF (difference between before and after pyeloplasty) between the 2 groups (P < .05). There were no significant differences in changes in parenchymal thickness and APD. Patients who waited 1-2 months had a significantly lower functional improvement compared with those who waited less than 1 month. CONCLUSION: Early surgery leads to a significant improvement in DRF. Wait times greater than 1 month can decrease functional improvement. For patients with prenatally diagnosed SFU grades 3-4 UPJO, early pyeloplasty is recommended in those with increasing renal pelvic APD and an obstructed renogram with differential renal function <40%.
OBJECTIVE: To evaluate changes in functional and morphological outcomes in children with prenatally diagnosed Society of Fetal Urology (SFU) grades 3-4 ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty at different ages. We also examined the effect of surgical wait time on recovery of renal function. MATERIALS AND METHODS: All patients (aged 0-12 months) with prenatally diagnosed SFU grades 3-4 UPJO who underwent pyeloplasty in a single center between January 2013 and December 2015 were reviewed. One hundred thirty-three children were enrolled in this study. The children were divided into 2 groups according to their age at the time of surgery (group I: 0-3 months, group II: 3-12 months). We evaluated changes in parenchymal thickness, anteroposterior diameter (APD), and differential renal function (DRF) using ultrasound and diuretic renography. Functional and morphological outcomes were compared using Student t test. RESULTS: A total of 133 patients were included in the study. We found a significant difference in the change of DRF (difference between before and after pyeloplasty) between the 2 groups (P < .05). There were no significant differences in changes in parenchymal thickness and APD. Patients who waited 1-2 months had a significantly lower functional improvement compared with those who waited less than 1 month. CONCLUSION: Early surgery leads to a significant improvement in DRF. Wait times greater than 1 month can decrease functional improvement. For patients with prenatally diagnosed SFU grades 3-4 UPJO, early pyeloplasty is recommended in those with increasing renal pelvic APD and an obstructed renogram with differential renal function <40%.
Authors: Mario Lima; Niel Di Salvo; Andrea Portoraro; Michela Maffi; Giovanni Parente; Vincenzo Davide Catania; Tommaso Gargano Journal: Children (Basel) Date: 2021-02-04