Pyelo-ureteral junction obstruction in poorly functioning kidneys: Does conservative management play a role in pediatric patients?
| Autor: | Zarfati A; Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; University of Rome Tor Vergata, Rome, Italy., Mele E; Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Villani MF; Department of Imaging, Nuclear Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Capozza N; Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Castagnetti M; Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy. |
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| Jazyk: | angličtina |
| Zdroj: | Frontiers in pediatrics [Front Pediatr] 2023 Mar 22; Vol. 11, pp. 1108170. Date of Electronic Publication: 2023 Mar 22 (Print Publication: 2023). |
| DOI: | 10.3389/fped.2023.1108170 |
| Abstrakt: | Background: Management of Pyelo-ureteral Junction Obstruction (PUJO) in poorly functioning kidneys in pediatric patients is still controversial, particularly regarding the role of conservative treatment. Aim: To evaluate and present the outcomes of internal diversion and follow-up results of a small series of pediatric patients with UPJO in poorly functioning kidneys. Study Design: Retrospective review of 17 consecutive patients with unilateral PUJO in kidneys with Differential Renal Function (DRF) <20% undergoing temporary internal urinary diversion between 2009 and 2021 at a single tertiary center. DRF was reassessed after 1-3 months of diversion and subsequent management was conservative or surgical (pyeloplasty or nephrectomy) based on surgeon's and family's preferences without randomization. Results: After a trial of internal urinary diversion, 4/17 patients (23%) showed a DRF increase ≥5% (9%-12%), up to a maximum DRF of 28%, 3 underwent pyeloplasty, while 1 was managed conservatively. The remaining 13 patients showed no differential renal function improvement after diversion, and 7 were managed expectantly while 6 surgically (4 pyeloplasty, 2 nephrectomy). Overall, nine patients (53%) were managed surgically and 8 (47%) expectantly After a median (range) follow-up of 3.1 (0.3-7.9) years, no significant difference was observed between groups regarding symptoms ( p = 0.205), need for further surgery ( p = 1.000), and renal function ( p = 1.000). Discussion: Although fraught with the limitation of a small sample size, this is the first study reporting on the conservative management of this controversial group of patients. Conclusion: In present pediatric series of pyelo-ureteral Junction obstruction in poorly functioning kidneys with differential renal function <20%, function recovery after a trial of internal urinary diversion was quite exceptional, and no difference was observed in outcome between patients managed surgically and conservatively after stent removal. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Zarfati, Mele, Villani, Capozza and Castagnetti.) |
| Databáze: | MEDLINE |
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