Evaluation of Renal Function After Percutaneous Nephrostomy in Obstructive Uropathy Due to Ureteropelvic Junction Obstruction

Objective: The present prospective study was conducted to evaluate the renal function after percutaneous nephrostomy (PCN) in obstructive uropathy due to ureteropelvic junction obstruction. Patients of UPJ obstruction irrespective of sex upto 15 years of age and split renal function (SRF) of the affected kidney <10% were enrolled in the study. Methods: The present prospective study was carried out at the Department of Urology, Dhaka Medical College Hospital from January 2007 to December 2008. The patients having ureteropelvic junction (UPJ) obstruction with poor renal function were the study population. Patients of either sex up to 15 years of age and split renal function < 10% (unilateral and / bilateral) were enrolled in the study. Patients with other anatomical abnormality of urinary system, concomitant pathologies like stone, pyonephrosis or previous surgical intervention of kidney and/or ureter were excluded from the study. Baseline variables were flank mass, flank pain, side of hydronephrosis, split renal function (SRF), glomerular filtration rate (GFR), specific gravity of urine at the time of PCN. Postoperative follow up variables (at 2, 4 and 6 weeks) were split renal function (SRF), glomerular filtration rate (GFR), specific gravity urine draining through nephrostomy tube, volume of urine through nephrostomy tube and complications. Data were collected using a structured questionnaire (research instrument) containing all the variables of interest. Data were processed and analysed using SPSS (Statistical Package for Social Sciences). The test statistics used to analyse the data were descriptive statistics and Repeated measure ANOVA. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. Result: The mean age of the patients was 8.6 ± 3.9 years and the lowest and highest ages were 3 months and 15 years respectively. The poorly functioning kidneys demonstrated a steady increase in SRF from 3.6% at baseline to 23% after 6 weeks PCN (p < 0.001). SRF of all children except 4 improved significantly during the period. The mean GFR of poorly functioning kidneys was 3.5ml/min/1.73 sq-meter at baseline which increased to 28.4 ml/min/1.73 sq-meter at the end of week 6. The GFR of 34 children improved (> 10 ml/min/1.73 sq-meter at the 6 week of treatment. Four cases (10.5%) did not improve. The specific gravity of urine significantly increased from 1.009 at baseline to 1.019 after 6 weeks. The volume of urine at 2nd week was 338 ml/24hour which sharply increased to 363 ml/24 hours at week 4 and nearly 386 ml/24hours after 6 weeks of PCN (p < 0.001). Conclusion: Present study recommends that as the likelihood of recovery of a severely damaged kidney (SRF < 10%) with UPJO following PCN is fairly satisfactory; none of the children with poorly functioning kidney should undergo nephrectomy without subjecting them to a PCN trial. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.36-41

A prospective study antenatally detected hydronephrosis and their postnatal evaluation and management

Background: Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. To analyse the incidence of ureteropelvic junction (UPJ) obstruction in antenatally detected hydronephrosis cases.Methods: This prospective study was conducted February 2019 to August 2019 at the Institute of Child Health and Hospital for Children Egmore, Chennai. All the cases of hydronephrosis which were detected antenatally and those children presented with hydronephrosis in the neonatal period were taken for this study. Totally 58 cases were analyzed in the study, among that 32 cases detected antenatally with UPJ obstruction. Their epidemiology and their immediate postnatal findings (USG abdomen by 3-7 days, IVP and DTPA by 4-6 weeks) were recorded and the percentage of cases in which pelvic-ureteric junction obstruction was significant.Results: Among the cases that were diagnosed to have hydronephrosis antenatally (46), 69% (32/46) had UPJ obstruction, 21% (10/46) had bilateral hydronephrosis, 6.5% (3/46) had vesicoureteric reflux and rest had other anomalies (1/46).Conclusions: Antenatal hydronephrosis (ANH), one of the most common abnormal findings on the antenatal ultrasound (US), continues to increase as the standard of care includes the 2nd trimester US. US is the mainstay of the postnatal evaluation and voiding cystourethrogram may be safely reserved for high-grade ANH or dilated distal ureter. New urinary biomarkers may offer promising potential for more accurate risk stratification in the near future.

Comparative Proteome Analyses of Ureteropelvic Junction Obstruction and Surrounding Ureteral Tissue

Ureteropelvic junction (UPJ) obstruction is a common problem in children, but its etiology remains unclear. In this study, the proteome profiles of the obstructed segment and its surrounding distal and proximal parts were comparatively evaluated. Twelve children younger than 2 years of age with unilateral intrinsic UPJ obstruction were included. The excised operational tissue was divided into three parts immediately after resection: the obstructed part (Obst), the distal normal ureteral part (Dist), and the proximal part of the obstructed segment (Prox). Proteins extracted from the tissue samples were subjected to two-dimensional gel electrophoresis analysis to identify differentially regulated proteins. Spot analysis revealed that four proteins, namely tropomyosin beta and alpha-1 chains, actin and desmin, were upregulated in Obst in comparison to Dist. A similar analysis between Obst and Prox showed that heat shock protein beta-1 and carbonic anhydrase-1 were upregulated in Obst, while tropomyosin alpha 3 chain and ATP synthase beta were upregulated in Prox. The last comparative analysis between Dist and Prox revealed upregulation of annexin-A5 and annexin-A1 in Dist and vimentin, mitochondrial ATP synthase subunit-beta, peroxiredoxin-2, and apolipoprotein-A1 in Prox. Bioinformatics analysis using the STRING server indicated that the differentially regulated proteins, altogether, point to the changes occurring in muscle filament sliding pathway. When regulations occurring in each group were mutually compared, a change in lipase inhibition activity was detected by STRING. This is the first study scrutinizing changes occurring in protein profiles in UPJ.

Reverse Tubularized Pelvis Flap Method for the Treatment of Long Segment Ureteropelvic Junction Obstruction

Objective: The most common cause of urinary obstruction is ureteropelvic junction (UPJ) obstruction. In short stenosis, a dismembered pyeloplasty is performed, but for long segment stenosis, the procedure is not well defined. We present the reverse flap ureteroplasty method, which we prepared from the pelvis for use in long segment UPJ obstruction. Methods: Between 2007 and 2016, we operated on 6 cases (4 males, 2 females) with an age range of 2–6 months. After reaching the UPJ region, depending on the length of the long segment obstruction, a flap measuring 25–35 mm in length was prepared from the pelvis so that its width would be 10–12 mm on the pelvis side and 10 mm in the distal portion. It was then reversed and tubularized with an absorbable suture over a 10-French nelaton catheter. The end of this ureter and the end of the distal ureter were spatulated and anastomosed. A double J and minivac drain were used in each case. Results: There were no complications in the postoperative period of all our patients. They were all discharged with good health. Follow-up with renal ultrasonography showed that the anteroposterior diameters were decreased and that parenchymal thicknesses had returned to normal. Secondary stenosis, flap necrosis, and retraction did not develop. Conclusion: Because the blood supply of the pelvis is increased in patients with UPJ obstruction, a reverse flap of adequate length with preserved blood supply can be achieved and tubularized. We suggest that this method will be appropriate for the treatment of long segment UPJ obstruction.