PA Cornford, AMK Rickwood [ Alder Hey Children’s Hosp, Liverpool, England ]
Functional Results of Pyeloplasty in Patients with Ante-natally diagnosed Pelvi-Ureteric Junction (PUJ) Obstruction
Br J Urol 81 : 152-155, 1998
Method – Between 1984 and 1995, 321 patients were referred with a diagnosis of antenatal hydronephrosis and were shown to have PUJ obstruction. Pyeloplasty was performed if the relative renal function evaluated deteriorated renographically before and at least 1 year after surgery.
Results – 2 patients had post operative urinary tract infection. From at total of 47 pyeloplasties . renographic reassessment showed no cases of continuing obstruction. Relative renal function was stabilized in patients who underwent early pyeloplasty. The mean differential function increased from 28.1% before surgery to 32.7% after surgery.
Among patients who underwent pyeloplasty after a period of expectant management the mean relative function decreased from 44.8% initially to 30.5% before surgery. At postoperative reassessment there was a recovery of 37.5% indicating a statistically significant loss of function.
Conclusion – Peloplasty failed to significantly improve function in patients born with PUJ obstruction and impaired renal function perhaps because of cortical loss. Thus, although early pyeloplasty stabilizes function, expectant management must be vigilant to prevent a small but modest loss of renal function.
CR Pal, JRD Tuson , DRM Lindsell, et al [ John Radcliffe Hosp, Oxford, England]
The Role of Micturating Cystourethrography in Antenatally Detected Mild Hydronephrosis
Pediatr Radiol 28 : 152-155, 1998
Conclusion – All infants with mild hydronephrosis should undergo MCUG. This assessment need not be delayed until 3 months, rather, it would be performed after a 6 week US scan.
EA Kurzrock, LS Baskin, BA Kogan [ Univ of California, San Francisco]
Gastrocystoplasty : Long-Term Follow-up
J Urol 160: 2182-2186, 1998
For 41 patients [79 renal units], preoperative and postoperative renal US studies were available for comparison, 75 of the units exhibited a stable or improved upper tract. No hydronephrosis was present preoperatively or postoperatively in 46 renal units. Of 33 renal units that had hydronephrosis preoperatively 21 improved, 8 stabilized, and 4 worsened. There were no significant changes in serum sodium, potassium, and creatinine levels.
The mean serum chloride level decreased 2.7mEq/L, and bicarbonate level increased 3.3 mEq.L. There was a mean increase of 177 cc in pressure specific
bladder volume at less than 20 cm water. Mean maximum bladder pressure decreased from 35 to 13 cm water.
Mucus production was not a problem, and no patient required routine bladder irrigation. Symptoms of the hematuria-dysuria syndrome were present in 27% of the patients.
Conclusions – Long-term follow-up confirmed the advantages of gastrocystoplasty over intestinal augmentation. Gastrocystoplasty stabilized or improved the upper urinary tract in 95% of the renal units, the result of increased bladder volume and decreased storage pressure.