الفهرس | Only 14 pages are availabe for public view |
Abstract Ureteropelvic junction obstruction (UPJO) is a common congenital urologic anomaly that is commonly complicated by loin pain, urinary infection, renal deterioration, stone formation, and hypertension. Open Anderson-Hynes dismembered pyeloplasty remains the gold standard treatment of ureteropelvic obstruction, although the previous century was witness to many competing techniques. Minimally invasive approaches are rapidly becoming the first-line treatment option. Improved skills of laparoscopic surgeons and use of robotic assistance have increased the surgical success rates and already made minimally invasive approaches the first-line therapy at most institutions. Use of internal stents during pyeloplasty is an urological dogma, which is thought to facilitate good drainage and be an effective guide for healing tissues by providing support and alignment. Nonetheless, the use of stents is not free of complications. As such, the use of stents has been questioned by many researchers, and in the era of open surgery, stentless pyeloplasty was reported to be safe in children. The present study aimed to present the success rate of stentless open pyeloplasty, compared with the stented counterpart. Between August 2014 to May 2016 the study included 20 pediatric patients with primary UPJO; 16 cases were males (80%) and 4 cases were females (20%), 10 cases were right sided (50%) and 10 cases were left sided (50%) and their mean age was 6.75 (± 4.53). These patients were underwent Anderson-Hynes pyeloplasty. They are divided randomly into two groups; group I: 10 cases who were underwent stented pyeloplasty (DJ stent) Group II: 10 cases who were underwent non- stented pyeloplasty. Most of the patients were asymptomatic (55%) and were discovered incidental during examination for another purpose or prenatally, while the remaining (45%) were complaining of pain; loin pain (40%) & vague abdominal pain (5%). All case were investigated by Urine Microscopy culture and sensitivity with posisitive culture in two cases; those cases postponed until completely relived from UTI and the new M, C &S became free. The preoperative ultrasonography revealed different degrees of hydronephrosis varied from mild to marked hydronephrosis in USS; 6 cases mild, 7 cases moderate and 7 cases marked hydronephrosis. Diuretic renogram was done as main method for diagnosis of the obstruction which revealed good renal function in most of cases (split renal function > 10%) with definite obstruction in all cases with mean differential function was 31.523 ± 4.252 in the stented group vs 4.252 ± 6.998 in the nonstented group. The mean operative time was longer in the stented group than the nonstented group 83 minute ±4.83 vs 70.50 minute ±4.73 respectively, but it wasn’t significantly longer. The overall postoperative complication was 15 % in the form UTI in one case (5%) in the stented group and 2 cases (10%) developed urinoma, clot obstruction in the non-stented group. Follow up of the cases was done every 2 weeks for 1 months, after 3 months then after 6 months. The follow up of these case reveled improvement of degree of hydronephrosis except 4 cases with residual hydrocalycosis but good patency and funneling in UPJ; 3 in the stented group and 1 in the non-stented group. And 2 cases showed worsening of the hydronephrosis; one in each group who were recurrent. All the cases revealed good renal function preoperatively with significant improvement in split renal function after operation with no significant difference between the stented and the non-stented group. The mean split renal function postoperatively was 49.5 ± 4.24 in the stented vs 47.30 ± 1.98 in the non-stented. The overall success rate was 90% in both groups; 1 case remained obstructed in each group. So there is no significant difference in the success rate between the two groups. |