Pelvi-ureteric Junction Obstruction Research Articles

Contemporary diagnosis and management of pelvi-ureteric junction obstruction.

Pelvi-ureteric junction obstruction (PUJO) is defined as a functionally significant impairment of the flow of urine from the kidney's renal pelvis into the proximal ureter. Symptomatically, the patient may experience flank pain, recurrent infections, stone formation, and impairment of renal function. Although many cases of intrinsic PUJO are diagnosed at birth, a minority of patients may present in adulthood with previously silent disease or develop secondary PUJO to other causes. PUJO is therefore broadly categorised into both primary and secondary PUJO. A wide array of diagnostic scans and tests are available to aid in diagnosing and monitoring patients with PUJO. In patients with compromised renal function or symptomatic PUJO that require intervention, minimally invasive techniques are the 'gold standard' for surgical intervention. This review will detail the endoscopic, laparoscopic, and robotic options available to the urologist practicing in 2021, including the use of autografts and other emerging technologies.

Nephrectomy – A study of recent trends in a high-volume tertiary care center, exploring the need for screening and preventive strategies

Background: Nephrectomy being one of the most commonly performed procedures, a retrospective study and analysis was done to evaluate, the scope for screening and timely preventive measures that could help to reduce the need for nephrectomy. Aims and Objectives: The aim of the study was to study indications, demographic-details, clinical-presentations, time delay, comorbidities, operative procedures, and complications of patients undergoing nephrectomies. The study was to identify the high risk groups, assess for feasibility for screening measures, and formulate strategies for nephrectomy prevention for benign etiologies. Materials and Methods: A retrospective study was done on medical records of 220 consecutive nephrectomies from June 2018 to June 2020. Results: Out of 220 nephrectomies, 68% were performed for benign conditions, 17% for malignant etiology, and 15% were donor nephrectomies. In the benign group, the most common etiology was renal stones (44.54%), followed by pelvic ureteric junction obstruction (12.72 %), and renal tuberculosis (6.81%). The most common clinical presentations were flank pain (80%), followed by lower urinary tract symptoms (22%), dysuria (25%), hematuria (15%), and fever (7%). In the malignant group, the most common etiology was renal cell carcinoma (14.09%). The most common clinical presentations were flank pain (90%) followed by hematuria (67%). Overall, 24% of the patients presented with acute kidney injury. A pre-operative intervention such as DJ stenting and percutaneous nephrostomy insertion was performed in 13% and 9% of patients, respectively. A laparoscopic approach was used in 76% of the patients out of which 10% were converted to open procedures. Partial nephrectomy was performed in 3% of patients. Conclusion: There is a difference in nephrectomy indications between Western countries and India, where 68% of nephrectomies are performed for benign conditions especially calculus disease. Nephrectomy for calculus disease is potentially preventable and public education in the form of posters, media and the involvement of the community medicine department could be helpful.

Pelviureteric Junction Obstruction Due to Vascular Anomalies in Children - Simple Surgical Options.

ABSTRACTAims:Pelviureteric junction obstruction (PUJO) due to aberrant lower polar artery is conventionally managed with pyeloplasty. We present our experience of managing PUJO due to “vascular” anomalies-aberrant lower polar artery and vascular adhesions with simpler surgical options.Subjects and Methods:This is a protocol based, retrospective study of PUJO. Preoperative investigations included ultrasonography (USG) and diuretic renogram. An intraoperative methylene blue test (MBT) assessed transit across the Pelviureteric junction (PUJ) after release of vascular compression. Surgical management included adhesiolysis for vascular adhesions and pyelopyelostomy anterior to the aberrant polar artery. Postoperative studies were repeated after 3 and 6 months.Results:Fourteen of 144 PUJO (9.7%) were “vascular” obstructions. Those with vascular adhesions (six) were largely infants with antenatal hydronephrosis. Children with aberrant lower polar artery (eight) were older, had fleeting symptoms, minimally increased pelvic diameter and subtle impairment on diuretic renogram. Majority were term males with urinary tract infection. The MBT showed normal transit across the PUJ in all. Postoperatively, there was progressive improvement on USG and diuretic renogram after 3 and 6 months. None had any complication or redosurgeries. At a mean follow-up of 41.2 months, all are asymptomatic.Conclusions:PUJO due to extrinsic vascular anomalies is rare. Intraoperative evaluation with the MBT ruled out associated intrinsic pathology. We describe two simple surgical alternatives preserving the normal PUJ - adhesiolysis for vascular adhesions and pyelopyelostomy for aberrant lower polar artery. The preliminary outcomes are comparable to conventional pyeloplasty.

Evaluation of Interstitial Cells of Cajal-Like Cells at the Pelviureteric Junction in Children with Pelviureteric Junction Obstruction: A Prospective Study and Review of Literature.

Introduction:The etiopathogenesis of pelviureteric junction obstruction (PUJO) has been debated. Recently, the role of interstitial cells of Cajal-like cells (ICC-LC)has been studied and reported to be the cause of this functional obstruction. We studied the histopathology and ICC-LC density at PUJ and compared it with that of PUJ of the control group and distal ureteric margin of the study group.Methods:A prospective study was conducted which included PUJO patients in the study group and the renal tumor patients in the control group. Histopathological examination (muscle hypertrophy and fibrosis) and immunohistochemistry (ICC-LC density) were done. The muscle hypertrophy, fibrosis, and ICC-LC density at the PUJ in both the groups were compared. A similar comparison was performed between the findings at the PUJ and the distal margin in the study group.Results:The study and control groups included 37 PUJO patients and 13 Wilms tumor patients. The ICC-LC density at PUJ in the study group was significantly lower than that in the control group (P < 0.001) and that at the distal resected margin of the study group (P < 0.001). Significantly increased muscle hypertrophy (P < 0.001) and fibrosis (P = 0.002) were seen at PUJ in the study group compared to the control group. No significant association was noted between the ICC-LC density and muscle hypertrophy at PUJ and the distal resected margin in the study group.Conclusion:A significant decrease in the density of ICC-LC and increased fibrosis and muscle hypertrophy at PUJ in children with PUJO play a role in the etiopathogenesis of the disease.

Correlation of Plasma Renin Activity Values and Resistive Index on Ultrasound Doppler with Findings of Renal Dynamic Scan in Patients with the Society of Fetal Ultrasound grades 3 and 4 Unilateral Hydronephrosis.

Renal dynamic scans (RDS) despite being considered the gold standard for the diagnosis of pelvic ureteric junction obstruction (PUJO), fail to help resolve the dilemma about management issues in many patients. Multiple invasive and noninvasive methods are being studied to help the decision-making in these patients. We did this study to find correlation of plasma renin activity (PRA) values and resistive index (RI) on Doppler ultrasound with findings of RDS in patients with the Society for Fetal Urology (SFU) Grades 3 and 4 unilateral hydronephrosis (HDN) and also to determine the cut-off values of PRA and RI that could categorically acknowledge the success of pyeloplasty. Twenty patients with SFU Grades 3 and 4 unilateral HDN due to PUJO were enrolled. Demographic details were recorded. All underwent Anderson-Hynes dismembered pyeloplasty. Based on the follow-up RDS scans, these patients could fall into one of three categories- improved (successful), status quo, or deteriorated (unsuccessful). Outcomes were compared based on RDS (split renal function [SRF]), ultrasonography, and Doppler findings were done at 3 months of postoperative period. Follow up period was 3 months after Pyeloplasty. Seventeen patients had successful outcomes based on RDS findings, 12 had improvement in SRF (>5%), and 6 had normal drainage curves (t-t1/2<10 min). Three patients had indeterminate curves (t-t1/2between 10 to 20 min). Four had improvement on both the criteria, i.e., SRF and drainage curves. Among the three patients who showed no improvement in RDS, two were in "status quo" category and one patient showed deterioration. Seventeen patients also showed improvement in PRA and RI. No significant correlation between PRA and RI with SRF could be established. However, PRA was found to have good concordance with RDS (90%). No significant correlation could be demonstrated between SRF and the respective values of PRA and RI. However, PRA could act as an adjunct to predict the early success of pyeloplasty in view of good concordance with RDS. A larger trial with bigger cohort of patients is required to confirm our contention.

Laparoscopic Pyeloplasty in Paediatric Age Group with Standard Adult Sized Laparoscopic Instruments

Most paediatric patients attend Urology Outpatient Department with diagnosis of pelviureteric junction obstruction. Now-a-days laparoscopic pyeloplasty is increasingly been used for the pelviureteric junction obstruction in paediatric patients. In the present case series, four paediatric patients of pelviureteric junction obstruction with age group of six, seven, eight and 12 years underwent laparoscopic pyeloplasty with adult sized laparoscopic instruments with ports size of 5 mm and 10 mm. Outcomes were measured in terms of mean operative duration, mean hospital stay and complications and improvement in Glomerular Filtration Rate (GFR). Mean operative duration was 211 min , mean blood loss of 96.25 mL and mean hospital stay was 5.75 days. Mean preoperative and mean postoperative GFR (at three months) were 53.19 mL/min and 55.35 mL/min respectively. In postoperative period one patient had increased drain output of more than 250 mL up to postoperative day three. All four patients had minor complications like postoperative fever on postoperative and ileus which were managed conservatively. Mean postoperative follow up duration was six weeks when Double-J (DJ) stent was removed. All patients had good outcome in terms of being asymptomatic and decreased hydronephrosis on follow-up renal ultrasonography and increased function of operated kidney on renal scan at three months. Based on intraoperative and postoperative observations, adult sized laparoscopic instruments can be used with ease with changes in port position and length of instrument inserted , adult sized laparoscopic instruments can be a useful armamentarium for paediatric laparoscopic pyeloplasty in cases of unavailability or intraoperative instrumental damage.

ROLE OF SPLIT-BOLUS PORTAL VENOUS PHASE CT UROGRAPHY FOR KIDNEY AND URINARY TRACT DISEASES

Background: The conventional CT Urography technique involves a single bolus of injection with three acquisitions leading to multiple exposures. Split bolus CT Urography involves acquisition of parenchymal and excretory phases in a single scan thus reducing the number of scans and radiation dose. We propose to introduce novel split-bolus portal venous phase protocol that allowed to provide synchronous visualization of the renal corticomedullary, nephrographic, and excretory phases with good tumor and vascular enhancement in a single acquisition. Materials And Methods: Hospital based observational study carried out in the department of Radiodiagnosis, together with the help of department of urology, department of pediatrics and pediatrics surgery, SMS medical college, Jaipur on 100 patients including both pediatric and adult population . Results: Out of total 100 cases, maximum 33 cases were of bosniak cysts. Amongst them 28 were bosniak type I , 3 of bosniak type II and one case each of bosniak type III and type IV. Bosniak cysts were followed by 15 cases of ureteric strictures, with 12 amongst them were post-op cases and remaining having tubercular etiology. Next maximum number of cases were of PUJ Obstruction and CT urography was done to rule out vascular crossings as a cause of PUJO. Four out of the 9 cases were associated with vascular crossing causing PUJ obstruction. Single phase Conclusion: split bolus CTU protocol used in our study provides excellent renal parenchymal enhancement and adequate opacication of the collecting system for evaluation of kidney and urinary tract in children and adults in most of the cases with good diagnostic accuracy and minimal radiation exposure. It is also helpful in accurately diagnosing complications such as infections and renal strictures in these patients. It can be used as an alternate diagnostic tool in resource limited settings where MRI is not available.

Etiology of symptomatic upper urinary tract obstruction in southeast Nigeria

Background: The causes of upper urinary tract (UUT) obstruction vary from one geographical location to another, and across gender and age. Similarly, the site of obstruction along the ureter varies with the nature of the obstructing lesion. Data in this regard from southeast Nigeria are deficient. Objective: To determine the causes of symptomatic UUT obstruction in southeast Nigeria. Materials and Methods: The medical records of individuals with confirmed UUT obstruction presenting from January 2011 to November 2017 were reviewed for information on the cause and location of obstruction. In addition, the pattern of the obstructions caused by UUT stones was compared across the gender and age of individuals. All statistical analyses were done using SPSS® version 21. Results: The medical reports of 267 individuals are included for analysis. Overall, urinary stone is the most prevalent cause of UUT obstruction, with a male-to-female ratio of 1.25. From 50 years of age onward, obstructing UUT stones are commoner in females (χ2 = 5.03; P = 0.03). In addition, obstructing UUT stones are more common on the right (55.1%) and in the upper ureter (48.9%) in univariate analyses. Congenital pelvi-ureteric junction (PUJ) obstruction is observed to be the most prevalent congenital cause of UUT obstruction. Uterine fibroids in females and advanced prostate cancer in males are also notable causes of ureteric obstruction. Conclusion: Beyond urinary stone and congenitally defective PUJ, uterine fibroids and prostate cancer are other notable causes of ureteric obstruction in southeast Nigeria.

Early Evidence on Genetic Polymorphisms in Conferring A "Two-Hit" Propensity to Renal Injury in Asian Indian Children.

Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of end-stage renal disease in children. While certain nephrogenic genes have been incriminated in these malformations, data to identify the frequency of gene polymorphisms in Asian Indian children with CAKUT are scarce. This study was done to identify the effect of polymorphisms in paired-box gene 2 (PAX2), bone morphogenetic protein (BMP)-4, angiotensin-converting enzyme (ACE), and angiotensin II receptor Type 2 (AGTR2) nephrogenic genes on the development of CAKUT. In this prospective cohort study, 158 children <12 years old (86 cases with CAKUT and 72 age-matched controls) were analyzed. DNA from both sets was extracted from peripheral blood using the Keygen DNA extraction kit, and single-nucleotide gene polymorphisms (SNPs) in PAX2, BMP-4, ACE, and AGTR2 nephrogenic genes were detected by polymerase chain reaction (PCR) using previously published primers and PCR conditions. The presence of A allele SNP for AGTR2 gene at rs3736556 was found to be significantly correlated with the development of ureteropelvic junction obstruction and vesicoureteral reflux (VUR) with the TT allelic genotype having a lower incidence of pelviureteric junction obstruction (odds ratio [OR] 0.18 [95% confidence interval [CI], 0.06-0.55], P = 0.01) and VUR (OR 0.31 [95% CI, 0.11-0.91], P = 0.03). Furthermore, on substratification of the patients with the presence of the A allele of AGTR2, 24 out of 27 patients with scarring were found to harbor the D allele of the ACE gene, thus predisposing them to further renal damage. This study points to early evidence in the implication of nephrogenic genes in development as well as predisposition to renal injury in Asian Indian patients with CAKUT.

Partial pelviureteric junction obstruction secondary to BK virus infection early posttransplantation - A case report

A 63-year-old female presented to our hospital with progressive allograft dysfunction, declining urine output and fluid overload. She had undergone a second transplant 4 months before. Her evaluation revealed partial pelviureteric obstruction in her ultrasound. She underwent a renal biopsy which revealed BK virus infection. The pelviureteric obstruction improved with oral diuretics and her mycophenolate sodium was discontinued. The case illustrates a rare urological manifestation of BK virus infection which can present with symptomatic allograft dysfunction early posttransplantation.

The obstructive index in antenatal unilateral pelviureteric junction obstruction: A novel predictor of the failure of conservative management.

To find the impact of the obstructive index (OI) as a predictor of management in antenatal pelviureteric junction obstruction. Records of 135 cases of antenatally detected unilateral pelviureteric junction obstruction, selected for initial observation were retrospectively analyzed. All patients who underwent pyeloplasty on follow up were assigned to Group A. Those patients who were still on conservative management were assigned to Group B. The pelvic anteroposterior diameters of the affected (PAPD[A]) and normal kidney (PAPD[N]) of the same patient, along with the cortical thickness of the affected kidneys (CT[A]) and normal kidneys (CT[N]) on postnatal ultrasound scan, the T1/2 of the affected (T1/2 [A]) and normal kidneys (T1/2 [N]), the differential renal function (DRF), and the shape of the curve on a diuretic renogram were noted for each patient at 6 weeks. The OI was defined as (PAPD[A] × T1/2 [A]) / (PAPD[N] × T1/2 [N]). The median duration of follow up was 55 months (36-110). Median age at surgery was 12 months (4-80). Group A had 30 patients with 105 in Group B. On multivariate analysis, OI and shape of curve predicted need for surgery with statistical significance. Median OI in Group A was 18.9 compared to 4.82 in Group B (P < 0.001, Mann-Whitney). Using receiver operating characteristic analysis, the area under curve for the OI was 0.95. A level of 12.2 could predict failure of conservative management with a sensitivity of 93.3% and a specificity of 92.4%. The OI can reliably predict the need for surgery at a very early stage, thus avoiding repeated tests and saving time.

Retroperitoneal Robotic-Assisted Laparoscopic Pyeloplasty: A 10 Year Experience in a Single Institution.

Introduction: Pelvi-ureteric junction (PUJ) obstruction was traditionally treated with open pyeloplasty. In recent decades, the development of minimally invasive techniques, including laparoscopic and later robotic surgery, has transformed treatment. The transperitoneal approach has most commonly been undertaken, with a few institutions reporting outcomes of the retroperitoneal approach. We report our 10-year experience of retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP). Methods: A prospective database of 160 patients undergoing RALP between February 2010 and November 2019 was analyzed. Data were recorded on demographics, operative details, complications, and success rate. Success was determined as symptomatic improvement and/or an unobstructed renogram. Results: One hundred fifty-two cases (95.0%) were performed by using a retroperitoneal approach, and 8 (5.0%) were performed by using a transperitoneal approach. Mean age was 45.3 ± 17.4 years. Mean operating time was 139.4 ± 45.6 minutes. A surgical drain was placed in 57 (71.3%) of the first 80 cases and 15 (18.8%) of the second 80 cases. Median hospital stay was one night (range 1-27). One case was converted to open pyeloplasty due to dense inflammatory tissue and one to robotic-assisted nephrectomy due to severe adhesions around the PUJ. There were no blood transfusions. There were six major (>grade 2 Clavien-Dindo) postoperative complications in four patients (2.5%). Two (1.3%) grade 3a complications, urine leak and pain after stent removal, required nephrostomy. There were three (1.9%) grade 3b complications: migrated stent requiring ureteroscopy, perirenal hematoma requiring open evacuation, and stent re-insertion. One (0.6%) grade 4 complication required ventilatory support on intensive care. Eighteen patients received follow-up at an alternative hospital, and 13 were lost to follow-up. Of the remaining cases, 94.5% were successful. Conclusions: R-RALP is a safe and effective treatment for PUJ obstruction allowing predictably rapid discharge from hospital without the need for a routine surgical drain. To our knowledge, our study represents the largest single institution experience on RALP using a retroperitoneal approach.

Retroperitoneal fibrosis masquerading as pelvi-ureteric junction obstruction - Laparoscopic management.

IntroductionRetroperitoneal fibrosis (RPF) is a rare fibro-inflammatory condition which is characterized by development of extensive fibrosis throughout the retroperitoneum. It is classically centred over the anterior surface of the fourth and fifth lumbar vertebrae. It results in entrapment and extrinsic compression of retroperitoneal structures.Presentation of the caseWe present the case of a 69 years old man who was reported to have right pelvi - ureteric junction obstruction on computed tomography, but turned out to have RPF.DiscussionRetroperitoneal fibrosis commonly causes obstructive uropathy (either unilateral, bilateral or progressing from unilateral to bilateral) and if untreated, renal failure. It has high response/remission rates to glucocorticoid therapy. However, relapse rates are also high. Hence, close surveillance with serial laboratory and imaging investigations, after achieving remission, is key to long term disease control.ConclusionAlthough classical imaging findings, supportive laboratory markers and suggestive/diagnostic histopathology appearances for RPF are well documented, its accurate preoperative diagnosis is not always an assured certainty.

Coexistence of Pelviureteric Junction Obstruction and Vesicoureteral Reflux

Introduction: The most common upper urinary tract problem in children is obstruction at the pelviureteric junction. It happens with varying degrees of seriousness. Ultrasonography and DTPA (Diethylene Triamine Penta-acitic Acid) renography are commonly used to detect it. Objective: To find out the coexistence of ipsilateralpelviureteric junction obstruction with vesicourenteral reflux. Materials and Methods: This prospective study was conducted in the Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2006 to May 2007 over a period of 1 year 5 months. Thirty-five patients with unilateral hydronephrosis due to PUJ obstruction were included in this study (age: 1 month-15 years). Results were analyzed using Statistical Package for Social Science (SPSS). Results: Incidence of Vesicoureteral reflux (VUR) among pelviureteric junction (PUJ) obstruction patients was 8.6%. Of them Grade-I VUR was 33.3% and grade-II VUR was 66.7%. Mean age of the patients was 4.71 ± 1.97 years and with VUR was 9.33 ± 4.93 years. Male to female ratio was 4:1. Only 5.7% mothers had regular antenatal checkup and 28.5% had irregular. Majority of the patients 28 (80%) were presented with painless loin mass, 6 (17.1%) with fever, 8 (22.9%) with loin pain and 8 (22.9%) with failure to thrive. Three patients (8.6%) showed abnormal R/M/E and all of the abnormal R/M/E samples showed positive culture. Conclusions: Incidence of Vesicoureteral reflux (VUR) among pelviureteric junction (PUJ) obstruction patients was 8.6%. Medicine Today 2021 Vol.33(2): 94-97

Long term outcomes following pyeloplasty for unilateral pelviureteric junction obstruction in paediatric patients

Background: Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis. The gold standard treatment for PUJO is Anderson hynes (AH) dismembered pyeloplasty. The parameters to assess the post-operative outcomes of pyeloplasty include reduction in the AP diameter of the pelvis and increase in parenchymal thickness. The aim of the study was to find out the long-term outcomes following pyeloplasty for Ureteropelvic junction obstruction (UPJO) in paediatric patients.Methods: A prospective study was done from September, 2014 to January, 2019. All children above the age of 2 months who presented with unilateral PUJO were included in the study. All patients underwent ultrasound of the kidneys and diuretic renogram. All patients underwent AH dismembered pyeloplasty. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit.Results: 60 patients with unilateral intrinsic PUJO were included in this study. Post-operatively split renal function (SRF) improved in 42 patients, remained stable in 13, and deteriorated in 5 cases. Post-operative renal drainage improved in 40 patients, remained stable in 15 and deteriorated in 5. The degree of hydronephrosis deteriorated in 5 cases but improved or was preserved in 55 cases. The renal parenchyma deteriorated in 7 cases. Overall success rate of AH dismembered pyeloplasty was 92%.Conclusions: Dismembered pyeloplasty is a safe and effective treatment of PUJO in the pediatric population. Majority of the patients had an improved split renal function, renal drainage, cortical thickness, and decreased degree of hydronephrosis.

Can urinary biomarkers be used in the outcome assessment of pyeloplasty in children?

BackgroundTo compare the urinary biomarkers—beta 2-microglobulin (β2M), monocyte chemotactic peptide-1 (MCP-1), and transforming growth factor-beta (TGF-β1)—in the outcome assessment of children with pelviureteric junction obstruction (PUJO) undergoing pyeloplasty.MethodsA prospective study was conducted on children with PUJO who had pyeloplasty in a tertiary care center from July 2016 to March 2018. Urine samples were obtained from freshly voided urine samples before surgery and after 6 months of pyeloplasty. Ratio between the levels of biomarkers and urinary creatinine before and after surgery were compared.ResultsA total of 72 patients had pyeloplasty during this period. The mean levels of standardized urinary β2M, MCP-1 and TGF-β1 before surgery were 3.94 ± 4.06, 96.63 ± 117.68 and 310.65 ± 423.87, respectively, which was significantly higher than the corresponding values in the postoperative period, obtained after 6 months of surgery; postoperative mean values were 3.12 ± 3.95, 25.28 ± 32.06, 109.95 ± 118.72 (P < 0.001), respectively. Using Wilcoxon signed-rank test, fall of MCP-1 and TGF-β1 was more significant compared to β2M.ConclusionUrinary biomarkers (β2M, MCP-1 and TGF-β) offer an effective way of outcome assessment of pyeloplasty for PUJO in children, especially MCP-1 and TGF-β1.

Outcome assessment for pyeloplasty in pediatric age group on the basis of ultrasonography

At present, duration and methods of radiographic follow-up after pediatric pyeloplasty are not well defined. We prospectively studied pediatric age group patients to assess outcome for cases of pyeloplasty on the basis of ultrasonography and DTPA scan. : We assessed all cases of PUJ obstruction in age group 0-18 years, who got admitted in LLR hospital, Kanpur and underwent pyeloplasty. Patients were excluded if cause of pyeloplasty was acquired. Preoperatively patients underwent clinical evaluation with history and examination followed by radiological investigations including Renal USG &amp; DTPA scan. All patients were followed up postoperatively at 3, 6, 9 &amp; 12 months. In USG, renal parenchyma thickness, antero-posterior diameter of renal pelvis was assessed. In DTPA scan, differential renal function was assessed. Data of USG and DTPA scan were statistically compared. 32 patients who underwent pyeloplasty at a median age of 4.2 years were studied. Follow-up was done for 1 year. On the basis of our study, DTPA scan is better than renal USG to assess functional outcome after pyeloplasty in pediatric age group up to 6 months during follow-up. But results are comparable for follow-up during 9 &amp; 12 months postoperatively. The results of our study show that in the first 6 months, renal USG is not as much informative as DTPA scan to assess functional outcome after pyeloplasty but after 6 months, renal USG is equally effective as DTPA scan.Our study concludes that for poor resource countries, renal USG can be used to assess functional outcome after pyeloplasty in pediatric age group for post-operative follow-up, instead of costly &amp; scarcely available investigation like Renal DTPA scan.

Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review

Pelvic-ureteric junction obstruction (PUJO) is a common condition, and one of the lead causes of hydronephrosis in children. Currently, the gold standard treatment of PUJO is open surgery using the Anderson–Hynes-modified dismembered pyeloplasty technique. However, with the advancement of medical technology, several minimal invasive approaches were developed, including endoscopic, laparoscopic, and robotic approach, from which the best choice of surgical technique was yet to be determined. Considering the advantages and disadvantages of these methods, the recommended option is to tailor the best surgical approach to each individual patient, and to the surgeons’ preference and experience. Considering these recent advances, a new algorithm is proposed to choose the best minimal invasive modalities invasive treatment to treat PUJO.

Systematic review and meta-analysis of vascular hitch efficacy for pelvi-ureteric junction obstruction due to lower pole crossing vessels

Systematic review and meta-analysis of vascular hitch efficacy for pelvi-ureteric junction obstruction due to lower pole crossing vessels

Prevalence of Renal Hypertension In Apparently Healthy Term Newborns.

Introduction: Neonatal hypertension (HT) is an emerging challenge for neonatologists and pediatricians around the world. The prevalence of renal causes of neonatal hypertension due to congenital renal anomalies and malformations including obstructive uropathy and cystic kidney disease is not well estimated up till now. Early diagnosis of congenital renal anomalies is the corner stone of good prognosis and better outcome. Aim of the study: To determine the prevalence of neonatal renal hypertension in apparently healthy term neonates discharged in the first 48 h of life from two university hospitals. Methods: Two thousand apparently healthy appropriate for gestational age (AGA) term newborns had blood pressure (BP) measurements using the oscillometric technique All results of blood pressure were compared to estimated blood pressure values in percentile curves generated by Dionne et al. Results: There were 29 of 2000 (1.45%) screened newborns diagnosed as having systemic hypertension, our study showed that renal anomalies were the main causes of neonatal systemic hypertension. It represent (93.1 %) of total causes in our study, [with pelviureteric junction (PUJ) Obstruction (31%), polycystic kidney (24.1%), nephrocalcinosis (13.7 %), unilateral renal dysplasia (10.3%), renal hypoplasia (3.4%), unilateral multi cystic kidney (3.4%)].The remaining cases (6.9%) were due to aortic coarctation. No endocrinal cases was diagnosed in our study. Conclusion: This study showed that renal anomalies were the most common causes of neonatal systemic hypertension in apparently healthy term newborns. Beside that this study provided normative BP values for healthy full term AGA newborns in the first 48h of life. These values can be used in the evaluation of BP in newborns.