- Email: [email protected]
Does A Preoperative Percutaneous Nephrostomy Influence the Outcome of Pyeloplasty in Infants and Children?
S62
ESPU Programme 2009
# S08-6 (PP) DOES A PREOPERATIVE PERCUTANEOUS NEPHROSTOMY INFLUENCE THE OUTCOME OF PYELOPLASTY IN INFANTS AND CHILDREN? Evi COMPLOJ, Mark KOEN, Tanja BECKER, Christoph BERGER, Katharina MITTER and Marcus RICCABONA Krankenhaus der Barmherzigen Schwestern, Pediatric Urology, Linz, AUSTRIA
PURPOSE We evaluated the potential and outcome of a preoperative percutaneous nephrostomy (PCN) in infants and children with severe hydronephrosis (SFU grade IV) due to ureteropelvic junction obstruction (UPJO) focusing on pre- and postoperative splitfunction, histological findings of the UPJ and the reoperation rate.
MATERIAL AND METHODS We reviewed retrospectively the medical records of 257 patients who underwent pyeloplasty for UPJO between 1992 and 2008. In 27 patients a PCN was placed before pyeloplasty for various reasons.
Hydronephrosis and split function were investigated with diuretic renogram before PCN or pyeloplasty and one year after surgery. Histological findings and reoperative rate were compared in patients with (group 1) and without PCN (group 2).
group 2 preoperatively 44 % (11 e 71 %) and again 45 % (15 e 74 %) postoperatively. Histology revealed chronic inflammation of the renal pelvis in 60 % of the PCN patients vs. 8 % in the other group. The reoperation rate in group 1 was 11 % (3/27) and 4 % (9/ 228) in group 2.
RESULTS 27/257 patients with a mean age of 30 months (3 days e 176 months) received a PCN before pyeloplasty. The indication was urosepsis in 6, pain in 4, asymptomatic hydronephrosis in 16 and haematuria after abdominal trauma in 2. Initial renal split function in group 1 was 32 % (4 e 54 %) and one year postoperatively 28 % (21 e 54 %), in
CONCLUSIONS Preoperative PCN in severe hydronephrosis does not improve kidney function, causes chronic inflammation of the renal pelvis in a high percentage, increases the risk for reoperation and should be limited exclusively for septic hydronephrosis.
# S08-7 (PP) ROLE OF URETEROCALICOSTOMY IN CHILDREN: A FOLLOW UP STUDY Anna RADFORD1, David F.M. THOMAS2 and Ramnath SUBRAMANIAM1 1
St James’ Hospital, Paediatric Urology, Leeds, UNITED KINGDOM, 2St James’ Hospital, Department of Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE Dismembered pyeloplasty remains the main treatment for primary pelviureteric junction obstruction in childhood. However, ureterocalicostomy may be an alternative option in the presence of unfavourable anatomy or recurrent obstruction. Published data regarding ureterocalicostomy in paediatric patients is limited, with no large series reported since 1990. This study was undertaken to document and assess the outcome of ureterocalicostomy as both a primary and salvage procedure in a single centre series of 12 children managed over an 11 year period.
PATIENTS AND METHODS Seven girls and five boys underwent ureterocalicostomy under the care of two
surgeons between 1997 and 2008. Median age at operation was 8 years (range 2 17). In 7 children primary ureterocalicostomy was performed for horseshoe kidney (3 cases) and gross hydronephrosis with unfavourable anatomy (4 cases). In 5 children salvage ureterocalicostomy was employed for recurrent PUJ obstruction post pyeloplasty. Indications, surgical technique and outcomes were assessed by retrospective analysis of case notes and imaging.
RESULTS Similar operative techniques and post operative drainage were employed by both surgeons with a mean operating time of 151 minutes (range 80 e 240). Hospitalisation averaged 5 days (range 3 - 7). No early
complications were encountered. Mean follow up was 31 months (SD ¼ 26.7). Successful outcomes were recorded in 10 children (92%) but one child (8%) developed symptomatic recurrent obstruction at 5 months which was successfully corrected by a further procedure.
CONCLUSIONS We report the first paediatric case series of ureterocalicostomy since 1990. Our findings support the use of this procedure not only as a salvage technique for recurrent pelviureteric junction obstruction but also as an effective primary treatment for selected patients, particularly when associated with horseshoe systems.
ESPU Programme 2009
# S08-6 (PP) DOES A PREOPERATIVE PERCUTANEOUS NEPHROSTOMY INFLUENCE THE OUTCOME OF PYELOPLASTY IN INFANTS AND CHILDREN? Evi COMPLOJ, Mark KOEN, Tanja BECKER, Christoph BERGER, Katharina MITTER and Marcus RICCABONA Krankenhaus der Barmherzigen Schwestern, Pediatric Urology, Linz, AUSTRIA
PURPOSE We evaluated the potential and outcome of a preoperative percutaneous nephrostomy (PCN) in infants and children with severe hydronephrosis (SFU grade IV) due to ureteropelvic junction obstruction (UPJO) focusing on pre- and postoperative splitfunction, histological findings of the UPJ and the reoperation rate.
MATERIAL AND METHODS We reviewed retrospectively the medical records of 257 patients who underwent pyeloplasty for UPJO between 1992 and 2008. In 27 patients a PCN was placed before pyeloplasty for various reasons.
Hydronephrosis and split function were investigated with diuretic renogram before PCN or pyeloplasty and one year after surgery. Histological findings and reoperative rate were compared in patients with (group 1) and without PCN (group 2).
group 2 preoperatively 44 % (11 e 71 %) and again 45 % (15 e 74 %) postoperatively. Histology revealed chronic inflammation of the renal pelvis in 60 % of the PCN patients vs. 8 % in the other group. The reoperation rate in group 1 was 11 % (3/27) and 4 % (9/ 228) in group 2.
RESULTS 27/257 patients with a mean age of 30 months (3 days e 176 months) received a PCN before pyeloplasty. The indication was urosepsis in 6, pain in 4, asymptomatic hydronephrosis in 16 and haematuria after abdominal trauma in 2. Initial renal split function in group 1 was 32 % (4 e 54 %) and one year postoperatively 28 % (21 e 54 %), in
CONCLUSIONS Preoperative PCN in severe hydronephrosis does not improve kidney function, causes chronic inflammation of the renal pelvis in a high percentage, increases the risk for reoperation and should be limited exclusively for septic hydronephrosis.
# S08-7 (PP) ROLE OF URETEROCALICOSTOMY IN CHILDREN: A FOLLOW UP STUDY Anna RADFORD1, David F.M. THOMAS2 and Ramnath SUBRAMANIAM1 1
St James’ Hospital, Paediatric Urology, Leeds, UNITED KINGDOM, 2St James’ Hospital, Department of Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE Dismembered pyeloplasty remains the main treatment for primary pelviureteric junction obstruction in childhood. However, ureterocalicostomy may be an alternative option in the presence of unfavourable anatomy or recurrent obstruction. Published data regarding ureterocalicostomy in paediatric patients is limited, with no large series reported since 1990. This study was undertaken to document and assess the outcome of ureterocalicostomy as both a primary and salvage procedure in a single centre series of 12 children managed over an 11 year period.
PATIENTS AND METHODS Seven girls and five boys underwent ureterocalicostomy under the care of two
surgeons between 1997 and 2008. Median age at operation was 8 years (range 2 17). In 7 children primary ureterocalicostomy was performed for horseshoe kidney (3 cases) and gross hydronephrosis with unfavourable anatomy (4 cases). In 5 children salvage ureterocalicostomy was employed for recurrent PUJ obstruction post pyeloplasty. Indications, surgical technique and outcomes were assessed by retrospective analysis of case notes and imaging.
RESULTS Similar operative techniques and post operative drainage were employed by both surgeons with a mean operating time of 151 minutes (range 80 e 240). Hospitalisation averaged 5 days (range 3 - 7). No early
complications were encountered. Mean follow up was 31 months (SD ¼ 26.7). Successful outcomes were recorded in 10 children (92%) but one child (8%) developed symptomatic recurrent obstruction at 5 months which was successfully corrected by a further procedure.
CONCLUSIONS We report the first paediatric case series of ureterocalicostomy since 1990. Our findings support the use of this procedure not only as a salvage technique for recurrent pelviureteric junction obstruction but also as an effective primary treatment for selected patients, particularly when associated with horseshoe systems.