요관류나 이소성 요관을 동반한 완전중복요관의 상극신 요관에 대한 신우요관문합술 후 상극신의 변화

Abstract

Purpose Non conservative treatment such as heminephrectomy is considered the treatment of choice when the upper pole kidney in children with a complete ureteral duplication complicated with ureterocele or ectopic ureter is nonfunctional. The postoperative outcome of the upper pole kidney with a complete ureteral duplication after pyeloureterostomy was evaluated, and we focused on those children with undetected functions on the upper pole kidney before surgery.

Materials and Methods Between May 2002 and March 2006, we evaluated 28 children, 10 boys and 18 girls, who had undergone pyeloureterostomy for a complete ureteral duplication that was complicated with ureterocele or ectoplic ureter. Their mean age was 12.3 months. Ultrasound, 99mTc-dimercaptosuccinic acid (DMSA) scanning and voiding cystourethrography (VCUG) were performed preoperatively. The clinical courses were followed up with ultrasound at 1, 3, 6 and 12 months, and DMSA scanning was done between 6 and 12 months after surgery. The median follow-up period was 21.5 months.

Results Among the 12 children with cortical thinning seen on ultrasound, 10 showed thickening of the renal cortex within 12 months. All 16 children with Grade III or less hydronephrosis on the upper pole kidney were downgraded, and 10 out of them showed complete resolution or Grade I hydronephrosis within 6 months. 4 cases with no visible photon uptake at the upper pole kidney preoperatively showed hot uptakes at the defective spot between 6 to 12 months after pyeloureterostomy. 5 out of 28 children had urinary tract infection (UTI) within 3 months after surgery; however, this was easily controlled with oral antibiotics.

Conclusions The function of the upper pole kidney is recovered within 1 year after pyeloureterostomy in most of the cases with a complete ureteral duplication, regardless of the severity of hydronephrosis at the upper pole kidney. Pyeloureterostomy can be an alternative treatment modality for treating a complete ureteral duplication that's complicated with ureterocele or ectopic ureter due to pyeloureterostomy's lower morbidity compared to non-conservative surgery such as heminephrecotmy.