The Clinical Analysis Of23Cases Of Children With Severe Hydronephrosis Caused By UPJO

[Objective]To study the diagnosis and treatment of children with severe hydronephrosis causedby UPJO.[Methods]Retrospective analysis of the clinical data of23cases which children with severehydronephrosis caused by UPJO,from the pediatric surgery of the first affiliatedhospital of Fujian medical university from January2008to December2012.[Results]All of twenty three children done check of B ultrasound before the operation,andmade a definitive diagnosed by combining with MRU、CTU、SPECT and otherexaminations,selective operation of disarticulation type yeloureteroplasty,among threechildren (13%) one stage done renal fistulization firstly,and then two stage donedisarticulation type pyeloureteroplasty after three week to one month,all ofpostoperative kidney are preserved.One children (4.4%) due to urinary extravasationextended to15days to removal of ureteral stent tube,the remaining twenty twochildren (95.6%) removaled of ureteral stent tube in about ten days.Removaled ofureteral stent tube one to two days later,nephrostomy tube injected from methyleneblue for color development or iodine oil radiography examination for understandwhether anastomotic was unobstructed,of which eleven children (47.8%) with iodineoil angiography showed anastomotic was unobstructed,no anastomotic urinaryleakage or stenosis occured,five children (21.7%) with iodine oil angiography stillshowed the presence of anastomotic stenosis,seven children (30.5%) with iodine oilangiography showed ureteral without development,but the contrast agent could bedeveloped in the bladder,the injection of methylene blue could be smoothlydischarged with the urine.There were two children (8.7%) merger of urinary tract infection in preoperative,appeared the situation of infection aggravated such as fever、pyuria in postoperative,and the infection were controlled after active treatment.Theother children recovered well after operation,smooth removaled of nephrostomytube,and leaved hospital after recovery.All of children were followed up periodicallyafter discharge, review of the B ultrasound showed the extent of hydronephrosis wererelieved or disappeared.There were no secondary inpatient operation cases because ofanastomotic stenosis or the aggravation of hydronephrosis.[Conclusions]1.All of children with severe hydronephrosis caused by UPJO can be diagnoseddefinitely by B ultrasound、MRU or CTU and SPECT,and SPECT can be used forquantitative determination of the renal function of kidney.2.Children with severehydronephrosis caused by UPJO once diagnosed, operation treatment is needed assoon as possible;For giant hydronephrosis but also could determine whether keep thekidney,could do renal fistulization firstly,according to the recovery of children,thendetermined what the two stage operation method.3.UPJO is the most common causeof severe hydronephrosis, Mainly methods adopted is disarticulation typepyeloureteroplasty, pediatric patients may be placed ureteral stent external drainageduring intraoperative.4.Severe hydronephrosis in children should try to reservekidney.