CONGENITAL PELVI-URETERIC STENOSIS IN CHILDREN: CLINICAL STUDY OF 70 KIDNEYS
1984 Volume 75 Issue 3 Pages 476-483
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1984 Volume 75 Issue 3 Pages 476-483
Clinical study on the pelvi-ureteric (PU) stenosis in children were summerized in our department, and the special reference was made to the cases, whose postoperative courses were not uneventful.
In the past 9 and half years, we operated on 70 congenital PU stenoses in 64 children. Boys were 4 times more frequently affected than the girls. Infants under 1 year accounted for 23%. The main clinical presentations were high fever, abdominal distention and abdominal pain. The kidney on the left side was 4 times more commonly affected than on the right. Vesicoureteral reflux was demonstrated in 8 kidneys.
Several methods of pyeloplasty have been performed with good results in 60%, fair in 34% and poor in 6%. Anderson-Hynes dismembered technic has been employed in about three-fourth of the operations. The extratenal pelvis was resected in only one-third of the kidneys, in which the dilatation of the pelvis was marked even after the decompression of the hydronephrosis. Only one kidney was extirpated due to deterioration of renal function after the initial pyeloplasty.
Pyuria was present in about half of the children before the urological management. About eighty per cent of the children showed clear urine in half a year after the surgery.
In about 70% of the hydronephrotic kidneys, the urine excreted from the nephrostomy tube has amounted to 40-60% of the total urine volume. No kidney excreted less than 30% of the total volume.
Histological evaluation of the renal biopsy was made according to the index of renal histological alterations. Most of the kidneys showed well preserved parenchyma and only 9% revealed severe changes.
In 71% of the kidneys, the nephrostomy tube was removed within one month after the pyeloplasty. In the remaining 19 cases, whose nephrostomy catheter was left for more than 1 month, several factors were responsible: they were associated VUR, infection of the involved kideny, preoperative nephrostomy, single kidney and intrarenal type of hydronephrosis. Several technics to prevent the complications were discussed.
