scholarly journals Outcome analysis of early surgery and conservative treatment in neonates and infants with severe hydronephrosis

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110578
Author(s):  
Qi-Fei Deng ◽  
Han Chu ◽  
Bo Peng ◽  
Xiang Liu ◽  
Yong-Sheng Cao
Keyword(s):  
Renal Function ◽  
Conservative Treatment ◽  
Ureteropelvic Junction Obstruction ◽  
Renal Cortex ◽  
Outcome Analysis ◽  
Neonates And Infants ◽  
Functional Indices ◽  
Early Surgical Treatment ◽  
Better Than

Objective The treatment strategy and timing of ureteropelvic junction obstruction (UPJO) in infants remain controversial. This study aimed to compare the effect of early surgical treatment (EST) and conservative treatment (CT) on neonates and infants with UPJO and their recovery of renal function and morphology. Methods Eighty neonates and infants with severe hydronephrosis were enrolled in this study. They received early pyeloureteroplasty or CT. Diethylenetriamine pentaacetate was used to assess renal function. Results There were no significant differences in renal function or renal indices at baseline between the two groups. At 3 and 6 months of follow-up, the anteroposterior diameter of the renal pelvis and the Society of Fetal Urology grade in the EST surgery group were significantly lower compared with those at baseline. The thickness of the renal cortex was greater in the EST group than in the CT group at 3 and 6 months of follow-up. After follow-up for 6 months, renal function in the EST group was significantly better than that in the CT group. Conclusion EST accelerates the recovery of renal morphological and functional indices in neonates and infants with severe hydronephrosis.

Comments on a case of ureteropelvic junction obstruction with late progression in an adult female

2021 ◽  
Vol 88 (3) ◽  
pp. 247-250
Author(s):  
Carlo Gandi ◽  
Angelo Totaro ◽  
Riccardo Bientinesi ◽  
Emilio Sacco
Keyword(s):  
Renal Function ◽  
Natural History ◽  
Conservative Treatment ◽  
Gold Standard ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Case Description ◽  
Diuretic Renogram ◽  
History Of

Introduction: Ureteropelvic junction obstruction is a pathology typically diagnosed in childhood. Nevertheless, some clinically silent cases may be unnoticed until adulthood. Case description: We report the case of a 53-year-old female with hydronephrosis due to ureteropelvic junction stenosis diagnosed in the adulthood, who subsequently developed obstruction with progressive worsening of renal function without symptoms. Conclusion: The natural history of ureteropelvic junction obstruction is still obscure. Diuretic renogram is the gold standard for diagnosis and follow-up of ureteropelvic junction obstruction, but is weak in predicting the evolution of the disease, especially in patients with vague symptoms. Conservative treatment of adult patient with equivocal ureteropelvic junction obstruction seems reasonable, but requires a close clinical follow-up and strict patient compliance in order to promptly identify significant obstruction.

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

2020 ◽  
Vol 20 (2) ◽  
pp. 61-64
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
Rifat Zaman ◽  
Md Amanur Rasul ◽  
Akm Shahadat Hossain ◽  
Shafiqul Alam Chowdhury ◽  
...  
Keyword(s):  
Renal Function ◽  
Low Dose ◽  
Ureteropelvic Junction Obstruction ◽  
Percutaneous Nephrostomy ◽  
Ureteropelvic Junction ◽  
College Hospital ◽  
Medical College ◽  
Split Renal Function

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

scholarly journals Uretero-duodenal Fistula as a Result from Ureteropelvic Junction Obstruction Correction: Case Report

2020 ◽  
Author(s):  
Teeranop Choorit ◽  
Worapat Attawettayanon ◽  
Virote Chalieopanyarwong
Keyword(s):  
Conservative Treatment ◽  
Ureteropelvic Junction Obstruction ◽  
Standard Treatment ◽  
Minimal Invasive ◽  
Ureteropelvic Junction ◽  
Definitive Treatment ◽  
Duodenal Fistula ◽  
Invasive Management ◽  
Uncommon Complication

Uretero-duodenal fistula is an uncommon complication in urology. The cause of fistula have been reported as ureteral calculi, iatrogenic injury, trauma and malignancy. The gold standard treatment of uretero-duodenal fistula remains controversial. The most common management is nephrectomy and primary closure of fistula. We report a case of 67 yearold man with uretero-duodenal fistula after laparoscopic correction of ureteropelvic junction obstruction. In the era of minimal invasive management, we decided to use endoscopic and conservative treatment. The definitive treatment will be reconsidered if conservative treatment fails. We will discuss the steps of management and follow-up for this patient.

Efficacy of Three Renal Replacement Therapy Modalities for the Treatment of Acute Kidney Injury Caused by Wasp Sting

2021 ◽  
pp. 1-11
Author(s):  
Fugang Li ◽  
Li Liu ◽  
Dezheng Chen ◽  
Yong Zhang ◽  
Mingli Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Therapeutic Effects ◽  
Wasp Sting ◽  
Laboratory Results ◽  
Better Than

<b><i>Background/Aim:</i></b> This study mainly aimed to explore the therapeutic effects of 3 renal replacement therapy (RRT) modalities on acute kidney injury (AKI) caused by wasp stings. <b><i>Methods:</i></b> A retrospective study from September 2016 to December 2019 was conducted. Thirty-one patients with AKIs caused by wasp sting were selected and divided into 3 groups according to the initial RRT modality received, namely, (1) the intermittent hemodialysis combined with hemoperfusion (IHD + HP) group, (2) the continuous veno-venous hemodiafiltration (CVVHDF) group, and (3) the CVVHDF combined with HP (CVVHDF + HP) group. The laboratory results were measured and analyzed before treatment on the 3rd, 7th, and 14th days of treatment. The renal function outcomes and survival of the patients were investigated at 3 months follow-up. <b><i>Results:</i></b> The laboratory results of enzyme measures and inflammatory indicators in wasp sting patients increased significantly in the early stage and 3 RRT modalities were effective in reducing these indicators. In addition, continuous RRT modality (CVVHDF and CVVHDF + HP) showed better clearance of myoglobin than IHD + HP. The serum creatinine levels of patients in the 3 groups did not recover to baseline within 14 days after beginning treatment. Nevertheless, the CVVHDF + HP group was better than the CVVHDF group, and CVVHDF was better than the IHD + HP group on the 3rd day. The interleukin (IL)-6 and IL-10 levels in CVVHDF + HP and IHD + HP groups were obviously lower than those in the CVVHDF group on the 3rd day. In the follow-up study, the recovery rate of renal function in CVVHDF and CVVHDF + HP groups was significantly better than that in the IHD + HP group. <b><i>Conclusion:</i></b> Early RRT was effective in the treatment of patients with A KI caused by wasp sting. CVVHDF + HP and CVVHDF modalities were better than the IHD + HP group in venom clearance and renal function recovery.

Retrospective Outcome Analysis of Staged Flexor Tendon Reconstruction

2000 ◽  
Vol 25 (2) ◽  
pp. 168-174 ◽  
Author(s):  
T. G. FRAKKING ◽  
K. P. DEPUYDT ◽  
M. KON ◽  
P. M. N. WERKER
Keyword(s):  
Flexor Tendon ◽  
Outcome Analysis ◽  
Mean Power ◽  
Active Motion ◽  
Pinch Grip ◽  
Significant Difference ◽  
Contralateral Hand ◽  
Total Active Motion ◽  
Better Than

Forty staged flexor tendon reconstructions were done in 38 patients between 1991 and 1997. Results were assessed by clinical examination and questionnaire. At follow-up (mean, 35 months) a tenolysis had already been done in 12 cases. In the long fingers there was a significant difference between total active motion (187°) and total passive motion (237°). There was also a significant difference between active (24°) and passive (58°) IP motion in the thumbs. The mean power grip was 82%, pinch grip 74% and key grip 63% of the contralateral hand. None of the ten FPL reconstructions could be graded as excellent; four were good, using the criteria of Buck-Gramcko et al. (1976) . Twenty-eight of the FDP reconstructions had excellent or good results. These results were better than the subjective scores given by the patients, 24 of whom complained of functional problems in daily life at follow-up.

scholarly journals Outcome assessment for pyeloplasty in pediatric age group on the basis of ultrasonography

2021 ◽  
Vol 7 (2) ◽  
pp. 57-62
Author(s):  
Vasu Gautam ◽  
RK Maurya ◽  
RK Tripathi ◽  
Ajay Kumar ◽  
Pinaki Ranjan Debnath ◽  
...  
Keyword(s):  
Renal Function ◽  
Functional Outcome ◽  
Outcome Assessment ◽  
Clinical Evaluation ◽  
Renal Pelvis ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Better Than

At present, duration and methods of radiographic follow-up after pediatric pyeloplasty are not well defined. We prospectively studied pediatric age group patients to assess outcome for cases of pyeloplasty on the basis of ultrasonography and DTPA scan. : We assessed all cases of PUJ obstruction in age group 0-18 years, who got admitted in LLR hospital, Kanpur and underwent pyeloplasty. Patients were excluded if cause of pyeloplasty was acquired. Preoperatively patients underwent clinical evaluation with history and examination followed by radiological investigations including Renal USG & DTPA scan. All patients were followed up postoperatively at 3, 6, 9 & 12 months. In USG, renal parenchyma thickness, antero-posterior diameter of renal pelvis was assessed. In DTPA scan, differential renal function was assessed. Data of USG and DTPA scan were statistically compared. 32 patients who underwent pyeloplasty at a median age of 4.2 years were studied. Follow-up was done for 1 year. On the basis of our study, DTPA scan is better than renal USG to assess functional outcome after pyeloplasty in pediatric age group up to 6 months during follow-up. But results are comparable for follow-up during 9 & 12 months postoperatively. The results of our study show that in the first 6 months, renal USG is not as much informative as DTPA scan to assess functional outcome after pyeloplasty but after 6 months, renal USG is equally effective as DTPA scan.Our study concludes that for poor resource countries, renal USG can be used to assess functional outcome after pyeloplasty in pediatric age group for post-operative follow-up, instead of costly & scarcely available investigation like Renal DTPA scan.

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