A CLINICAL OBSERVATION ON PLASTIC SURGERY FOR HYDRONEPHROSIS
1972 Volume 63 Issue 8 Pages 641-648
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1972 Volume 63 Issue 8 Pages 641-648
A clinical observation on 15 cases of hydronephrosis (17 ureters) indicated for pyeloplastic surgery during the last 5 years in the Department is made, and the results obtained are as follows:
1. In 12 ureters of these patients, a plastic procedure, which comprises separation of the ureter from the pelvis, with excision of the pelvi-ureteric junction, and re-implantation of the ureter into the pelvis (Anderson-Hynes pyeloplasty), has been carried out.
2. Adopting I V P, radioisotope renogram and P S P test as a guide to the degree of improvement in function of the kidney, a “good” result was obtained in 7 of 17 pyeloplasties. In these good cases, the re-implantation methods of Anderson-Hynes and so forth, with excision of the pelvi-ureteric junction, have been carried out. These procedures provided better results compared with the pyeloplasty with retention of continuity between the ureter and pelvis.
3. In child group, the good result was obtained in a higher proportion than in adult group.
4. No significant relationships were observed between the degree of hydronephrosis and postoperative improvement.
5. In the patients whose internal diameter of the renal artery to that of abdominal aorta was less than 20 per cent in ratio, the renal cortex on the nephrogram was found to be of a great unsubstantial thickness. The ratio can be used as a determination factor on the indication for conservative surgery in the management of hydronephrosis.
6. In 4 cases (31 per cent) of unilateral hydronephrosis, the contralateral kidney, which showed apparently normal excretory pyelogram, revealed a considerable prolongation of excretory phase on the renogram. This would suggest the usefulness of the renogram in the diagnosis of hydronephrosis and assessment of the function of the contralateral kidney after the operation. This is also reminiscent of that hydronephrosis, potentially at least, is a bilateral affliction and conservative surgery is proposed in the management of hydronephrosis.
