Causes, clinical significance and results of surgical treatment for pediatric congenital hydronephrosis

Abstract

Background: Congenital pediatric hydronephrosis is swelling of one or both kidneys. Kidney swelling happens when urine can›t drain from a kidney and builds up in the kidney as a result. This can occur from a blockage in the tubes that drain urine from the kidneys (ureters) or from an anatomical defect that doesn›t allow urine to drain properly.In recent years, the increase in systemic and congenital defects occurring in children. Including kidney and urinary tract disorders are a number of cases occur quite often and late diagnosis. Hydronephrosis is the most common urogenital anomalia in children. UPJ obstruction is the most common cause for upper urinary tract obstruction occurring 1 in 2000 births.Laparoscopic pyeloplasty was reported in 1993 by Schuessler WW and its technique was dismembered pyeloplasty. Aim: The aim was to determine causes and clinical significances of the UPJ stricture and compare surgical outcome of laparoscopic and open pyeloplasty. Materials and Methods: In the period from 2020 to 2022. We have operated 57 ureteropyeloplasty cases. All the patients had UPJ obstruction and ureteropyeloplasty was performed. Both groups were compared according to the operative time and recovery duration. Demographic data including age, gender, operation time, estimated blood loss, hospital stay and complications were recorded. Results: Mean age was 5.89±4.68 in all the study children. A total of 57 (44 boy, 13 girl) were participated. Ureteropelvic junction stricture was occurred 94.7% in all cases. Compared to that open surgery, blood loss and hospital stay 2 days shorter than open surgery. But duration of operation time was longer than open surgery (155.9±62.1). There was statistical different (p=0.003) between parameters of 2 groups. In laparoscopic and open surgery group respectively, renal function was increased both groups and there was statistical different between 2 groups. Conclusion: 1. The most common cause of hydronephrosis is ureteropelvic junction stricture and abdominal pain is main clinical symptom in Mongolian children. 2. Compared to open surgery, laparoscopic surgery had less blood, fewer hospital stays and faster wound healing. But operation time was longer than open surgery. 3. Renal function was more improved laparoscopic surgery group after 6 months.