The results of dismembered flap pyeloplasty for hydronephrosis in children

Abstract

Aim. To evaluate the effectiveness of dismembered flap pyeloplasty for extensive obstruction of the pyeloureteral segment in children. Methods. Dismembered flap pyeloplasty throughout the period 2001-2010 was performed in 9 children (first group), mean age 69 months, 7 (77.8%) boys and 2 (22.2%) girls. Left-sided hydronephrosis was diagnosed in 8 (88.9%) cases, right-sided hydronephrosis - in 1 (11.1%) case. Dismembered flap pyeloplasty was performed in those cases, when after the resection of the ureter and during an attempt to form a direct uretero-pyelo-anastomosis excessive tension of the tissues occurred. In order to replace the resected part of the ureter used was a tubularized U-shaped flap of the renal pelvis, which was anastomosed in an «end to end» fashion with the proximal section of the ureter. The comparison group (second group, 58 patients) included patients who had undergone dismembered pyeloplasty with the formation of uretero-pyelo-anastomosis in the horizontal plane after standard resection of the dysplastic area of the proximal ureter. Results. In the early postoperative period, clinical manifestations of urinary tract infections were recorded in 1 (11.1%) of 9 patients, treated medically. The degree and rate of reduction of the increased anteroposterior size of the renal pelvis after dismembered flap pyeloplasty significantly lagged behind the comparable parameters of patients undergoing standard dismembered pyeloplasty, and at the same time, one year after the operation noted was a marked decrease in the anteroposterior size of the renal pelvis by almost 3 times as compared to the preoperative values. Conclusion. Implementation of dismembered flap pyeloplasty for extensive ureter obstruction makes it possible to achieve good short- and long-term results in the treatment of hydronephrosis in children.

Keywords

hydronephrosis / children / dismembered flap pyeloplasty

References

[1] Casale P., Mucksavage P., Resnick M., Kim S. Robotic ureterocalicostomy in the pediatric population // J. Urol. - 2008. - Vol. 180, issue 6. - P. 2643-2648.

[2] Culp O.S., De Weerd J.H. Pelvic flap operation for certain types of ureteropelvic obstruction. Preliminary report // Proc. Staff. Meet., Mayo Clin. -1951. - Vol. 5. - P. 483-488.

[3] Gill I.S., Cherullo E.E., Steinberg A.P. et al. Laparoscopic ureterocalicostomy: initial experience // J. Urol. - 2004. - Vol. 171. - P. 1227-1230.

[4] Harish J., Joshi K., Rao K.L.N. et al. Pelviureteric junction obstruction: how much is the extent of the upper ureter with defective innervation needing resection? // J. of Pediatr. Surg. - 2003. - Vol. 38, issue 8. - P. 1194-1198.

[5] Neuwirt K. Implantation of the ureter into de lower calyx of the renal pelvis // VII Congrés de la Société Francaise d’ Urologie. - 1947. - Vol. 2. - P. 253-255.

[6] Scardino P.L., Prince Ch.L. Vertical flap uretero-pelvioplasty: Preliminary report // South. Med. J. - 1953. - Vol. 46. - P. 325.

RIGHTS & PERMISSIONS

Sizonov V.V., Kogan M.I.