Tülay BECERİR, İlknur GİRİŞGEN, Hande ŞENOL, Olga YAYLALI, Osman UZUNLU, Selçuk YÜKSEL

Pediatrik Üreteropelvik Bileşke Darlığı Yönetiminde Tek Merkez Deneyimi

Üreteropelvik bileşke darlığı (UPD), tanısı ile izlenen çocuk hastaların yönetimi tartışmalıdır ve merkezlere göre değişkenlik gösterir. Bu çalışmada Pamukkale Üniversitesi Çocuk Nefroloji Kliniğinde UPD tanısıyla takip edilen hastaların başvuru ve izlem bulgularının değerlendirilmesi amaçlanmıştır. Pamukkale Üniversitesi Çocuk Nefroloji kliniğinde Ocak 2014 ile Ağustos 2021 tarihleri arasında UPD tanısı ile izlenen çocuk hastaların verileri retrospektif olarak değerlendirildi. Hastaların demografik ve klinik özellikleri, başvuruda, izlemde birinci yılda ve son kontrolde çekilen üriner sistem USG bulguları ve başvuruda ve birinci yılda çekilen Mercaptoacetyltriglycine (MAG3) sintigrafi bulguları incelendi. Hastaların 31’i (%70.5) erkek, 13’ü (%29.5) kızdı. Hastaların ortalama takip süresi 47.4 ± 31.1 (24-120 ay) ay olarak saptandı. Hastaların 18’inde (%˜41) UPD’e eşlik eden böbrek anomalisi mevcuttu. On dokuz hastaya piyeloplasti operasyonu uygulandı. Piyeloplasti uygulanan hastaların ilk başvuru USG bulguları ile 1. yıl USG bulguları değerlendirildiğinde parankimde incelme, pelvis ön-arka çapı genişliği bulgularında düzelme olduğu saptandı. Piyeloplasti yapılmayan hastalar arasında 3 hastanın USG bulgularının kötüleştiği görüldü. Veriler tekrar incelendiğinde bu üç hastanın operasyonu kabul etmeyen ailelerin çocukları olduğu saptandı. Piyelopilasti yapılan ve yapılmayan hastaların, ilk başvuru ve izlemde birinci yılda çekilen MAG-3 sintigrafisi bulguları arasında belirgin değişiklik yoktu. Bu çalışmada hem cerrahi hemde konservatif yaklaşım ile izlenen hastaların USG ve MAG3 sintigrafisi bulgularının stabil kaldığı veya iyileştiği saptanmıştır. Bu hasta grubunda USG ve MAG3 sintigrafisi sonuçlarının birlikte yorumlanması önemlidir. Özelikle konservatif yaklaşıma karar vermede ailelerin takip planlarına uyum sağlayıp sağlayamayacakları da göz önüne alınmalıdır.

Anahtar Kelimeler:

üreteropelvik darlık, çocuk, hidronefroz

Single Center Experience in Pediatric Ureteropelvic Junction Obstruction Management

Management of pediatric patients with the diagnosis of ureteropelvic junction obstruction (UPO) is controversial and varies according to centers. In this study, it was aimed to evaluate the admission and follow-up findings of the patients followed up with the diagnosis of UPO in Pamukkale University Pediatric Nephrology Clinic. The data of pediatric patients who were followed-up with the diagnosis of UPO in Pamukkale University Pediatric Nephrology Clinic between January 2014 and August 2021 were evaluated retrospectively. Demographic and clinical characteristics of the patients, urinary system USG findings at admission, at the first year of follow-up, and at the last follow-up, and Mercaptoacetyltriglycine (MAG3) scintigraphy findings at admission and at the first-year follow-up were analyzed. Thirty-one (70.5%) of the patients were male and 13 (29.5%) were female. The mean follow-up period of the patients was 47.4 ± 31.1 (24-120 months) months. Eighteen of the patients (˜41%) had renal anomaly accompanying UPO. Nineteen patients underwent pyeloplasty operation. First admission USG findings and 1st year USG findings of patients who underwent pyeloplasty were evaluated. It was determined that there was an improvement in the findings of thinning of the parenchyma and the width of the anterior-posterior diameter of the pelvis. Among the patients who did not undergo pyeloplasty, the USG findings of 3 patients deteriorated. When the data were re-examined, it was determined that these three patients were children of families who did not accept the operation. There was no significant difference between the MAG-3 scintigraphy findings at the first admission and the first year in the patients who underwent pyelopiplasty and those who did not. In this study, it was determined that the USG and MAG3 scintigraphy findings of the patients followed up with both surgical and conservative approaches remained stable or improved. It is important to evaluate USG and MAG3 scintigraphy results together in the management of this patient group. In particular, it should be taken into account whether families can adapt to follow-up plans when deciding on the conservative approach.

Keywords:

ureteropelvic stenosis, child, hydronephrosis ureteropelvic stenosis, child, hydronephrosis,

PDF

___

KAYNAKLAR 1. Krajewski W, Wojciechowska J, Dembowski J et al. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. Adv Clin Exp Med. 2017;26(5):857-64.
2. Szydelko T, Tuchendler T, Litarski A, et al. Laparoscopic Anderson-Hynes procedure as a treatment of ureteropelvic junction obstruction caused by fibroepithelial polyp. Wideochir Inne Tech Malo Inwazyjne. 2013;8:361–63.
3. Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89(2):149–56.
4. Braga LH, Ruzhynsky V, Pemberton J et al. Evaluating practice patterns in postnatal management of antenatal hydronephrosis: a national survey of Canadian pediatric urologists and nephrologists. Urology. 2014;83(4):909–14.
5. Weitz M, Schmidt M, Laube G. Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol. 2017;32(12):2203-13.
6. Onen A. Grading of Hydronephrosis: An Ongoing Challenge. Front Pediatr. 2020; 27;8:458.
7. Nguyen HT, Benson CB, Bromley B et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982-98.
8. Williams B, Tareen B, Resnick MI. Pathophysiology and treatment of ureteropelvic junction obstruction. Curr Urol Rep. 2007;8(2):111–17.
9. Ingraham SE, McHugh KM. Current perspectives on congenital obstructive nephropathy. Pediatr Nephrol. 2011;26(9):1453–61.
10. Çetin N, Tokar B. Çocuklarda Üreteropelvik Bileşke Darlığı: Tek Merkez Deneyimi. Fırat Tıp Dergisi. 2017; 22(2): 77-80.
11. Gopal M, Peycelon M, Caldamone A, et al. Management of ureteropelvic junction obstruction in children-a roundtable discussion. J Pediatr Urol. 2019;15(4):322-29.
12. Abadir N, Schmidt M, Laube GF et al. Imaging in children with unilateral ureteropelvic junction obstruction: time to reduce investigations? Eur J Pediatr. 2017;176(9):1173-79.
13. Kohno M, Ogawa T, Kojima Y et al. Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide. Int J Urol. 2020;27(5):369-376.
14. Arena S, Chimenz R, Antonelli E et al. A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr. 2018;177(12):1761-5.
15. Bayne CE, Majd M, Rushton HG. Diuresis renography in the evaluation and management of pediatric hydronephrosis: What have we learned? J Pediatr Urol. 2019;15(2):128-37.
16. Oh SJ, Moon DH, Kang W et al. Supranormal differential renal function is real but may be pathological: assessment by 99m technetium mercaptoacetyltriglycine renal scan of congenital unilateral hydronephrosis. J Urol. 2001;165:2300–4. 17. Moon DH, Park YS, Jun N-L et al. Value of supranormal function and renogram patterns on 99mTc-mercaptoacetyltriglycine scintigraphy in relation to the extent of hydronephrosis for predicting ureteropelvic junction obstruction in the newborn. J Nucl Med. 2003;44:725–31.
18. Vemulakonda VM, Sevick C, Juarez-Colunga E et al. Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network. Int Urol Nephrol. 2021;53(8):1485-95.
19. Chertin B, Pollack A, Koulikov D et al. Does renal function remain stable after puberty in children with prenatal hydronephrosis and improved renal function after pyeloplasty? J Urol. 2009;182(4 Suppl):1845-8.
20. Chandrasekharam VVS, Babu R, Arlikar J et al. Functional outcomes of pediatric laparoscopic pyeloplasty: post-operative functional recovery is superior in infants compared to older children. Pediatr Surg Int. 2021;37(8):1135-39.