Role of ureterocalicostomy in management of giant hydronephrosis in children in contemporary practice: Indications, outcomes and challenges
Given the rarity of giant hydronephrosis (GH), ideal surgical approach, assessment of drainage after surgery, expected improvement in renal function and morphological changes in the kidney on follow up have not been studied extensively. The aim of this study was to investigate the role of ureterocal...
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| Veröffentlicht in: | Journal of pediatric urology 2021-10, Vol.17 (5), p.657.e1-657.e7 |
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| creator | Ansari, M.S. Danish, Nayab Yadav, Priyank Kaushik, Vinay N. Kakoti, Shitangsu Kumar, Abhay Banthia, Ravi Srivastava, Aneesh |
| description | Given the rarity of giant hydronephrosis (GH), ideal surgical approach, assessment of drainage after surgery, expected improvement in renal function and morphological changes in the kidney on follow up have not been studied extensively. The aim of this study was to investigate the role of ureterocalicostomy (UC) in unilateral GH with respect to its current indications, outcomes and the challenges associated with it.
We retrospectively analysed data of 25 children (up to the age of 18 years) who underwent UC between January 2008 and January 2019 using open, laparoscopic or robotic-assisted approach. Preoperative workup included ultrasonography for pelvic anteroposterior diameter (APD) and cortical thickness (CT), and diuretic scan for split renal function (SRF) and drainage. Patients were followed with ultrasonography and diuretic renal scan at 3 months, after further 6 month and then annually.
The median age was 7 years and median follow-up was 22 months. Eight children underwent UC as salvage procedure while 17 children underwent UC as an upfront procedure. APD declined significantly (p |
| doi_str_mv | 10.1016/j.jpurol.2021.06.007 |
| format | Article |
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We retrospectively analysed data of 25 children (up to the age of 18 years) who underwent UC between January 2008 and January 2019 using open, laparoscopic or robotic-assisted approach. Preoperative workup included ultrasonography for pelvic anteroposterior diameter (APD) and cortical thickness (CT), and diuretic scan for split renal function (SRF) and drainage. Patients were followed with ultrasonography and diuretic renal scan at 3 months, after further 6 month and then annually.
The median age was 7 years and median follow-up was 22 months. Eight children underwent UC as salvage procedure while 17 children underwent UC as an upfront procedure. APD declined significantly (p < 0.001) and CT improved significantly (p = 0.009) after surgery. The drainage as well as SRF did not change significantly after surgery. Four children developed flank pain after stent removal; one required a redo-ureterocalicostomy for anastomotic stricture while another required balloon dilatation of the anastomosis. Two children responded to prolonged stenting for 2 months.
Ultrasonography (APD, CT), Diuretic renal scan (SRF and drainage pattern) are used to monitor HDN. APD is particularly important in GH because the diuretic renogram invariably shows an obstructive drainage owing to the large volume of the pelvicalyceal system. Similar to previous studies in literature, we too reported a decline in APD. CT improved in our study, however, the drainage pattern as well as SRF did not change significantly (Figure). Diuretic scan in isolation was not sufficient to predict failure. A combination of ultrasonographic and diuretic scan parameters were useful for follow up and for detection of failure. The success rate in our study was 92%. Chief limitations of our study were retrospective nature and lack of comparison with pyeloplasty. Moreover, some cases were performed with minimal invasive techniques, so the study group was heterogenous.
UC offers excellent outcome in children with GH due to primary as well as secondary UPJO. Isolated ultrasonographic or diuretic renogram parameters are not sufficient to predict failure and a combination of them should be used for follow up after UC. [Display omitted]</description><identifier>ISSN: 1477-5131</identifier><identifier>EISSN: 1873-4898</identifier><identifier>DOI: 10.1016/j.jpurol.2021.06.007</identifier><identifier>PMID: 34176750</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adolescent ; Child ; Follow-Up Studies ; Humans ; Hydronephrosis ; Hydronephrosis - diagnostic imaging ; Hydronephrosis - surgery ; Kidney - physiology ; Kidney Pelvis ; Kidney pelvis/ abnormalities ; Retrospective Studies ; Treatment Outcome ; Ureteral Obstruction - diagnostic imaging ; Ureteral Obstruction - surgery ; Urologic Surgical Procedures</subject><ispartof>Journal of pediatric urology, 2021-10, Vol.17 (5), p.657.e1-657.e7</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-e08b84cc2e1122b9634edf0dbfe8a607a6db915b5408368d092d9010fac10b763</citedby><cites>FETCH-LOGICAL-c362t-e08b84cc2e1122b9634edf0dbfe8a607a6db915b5408368d092d9010fac10b763</cites><orcidid>0000-0001-9783-0729 ; 0000-0001-8723-9732 ; 0000-0002-5477-0161 ; 0000-0002-4180-0456 ; 0000-0002-2509-0116</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpurol.2021.06.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34176750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ansari, M.S.</creatorcontrib><creatorcontrib>Danish, Nayab</creatorcontrib><creatorcontrib>Yadav, Priyank</creatorcontrib><creatorcontrib>Kaushik, Vinay N.</creatorcontrib><creatorcontrib>Kakoti, Shitangsu</creatorcontrib><creatorcontrib>Kumar, Abhay</creatorcontrib><creatorcontrib>Banthia, Ravi</creatorcontrib><creatorcontrib>Srivastava, Aneesh</creatorcontrib><title>Role of ureterocalicostomy in management of giant hydronephrosis in children in contemporary practice: Indications, outcomes and challenges</title><title>Journal of pediatric urology</title><addtitle>J Pediatr Urol</addtitle><description>Given the rarity of giant hydronephrosis (GH), ideal surgical approach, assessment of drainage after surgery, expected improvement in renal function and morphological changes in the kidney on follow up have not been studied extensively. The aim of this study was to investigate the role of ureterocalicostomy (UC) in unilateral GH with respect to its current indications, outcomes and the challenges associated with it.
We retrospectively analysed data of 25 children (up to the age of 18 years) who underwent UC between January 2008 and January 2019 using open, laparoscopic or robotic-assisted approach. Preoperative workup included ultrasonography for pelvic anteroposterior diameter (APD) and cortical thickness (CT), and diuretic scan for split renal function (SRF) and drainage. Patients were followed with ultrasonography and diuretic renal scan at 3 months, after further 6 month and then annually.
The median age was 7 years and median follow-up was 22 months. Eight children underwent UC as salvage procedure while 17 children underwent UC as an upfront procedure. APD declined significantly (p < 0.001) and CT improved significantly (p = 0.009) after surgery. The drainage as well as SRF did not change significantly after surgery. Four children developed flank pain after stent removal; one required a redo-ureterocalicostomy for anastomotic stricture while another required balloon dilatation of the anastomosis. Two children responded to prolonged stenting for 2 months.
Ultrasonography (APD, CT), Diuretic renal scan (SRF and drainage pattern) are used to monitor HDN. APD is particularly important in GH because the diuretic renogram invariably shows an obstructive drainage owing to the large volume of the pelvicalyceal system. Similar to previous studies in literature, we too reported a decline in APD. CT improved in our study, however, the drainage pattern as well as SRF did not change significantly (Figure). Diuretic scan in isolation was not sufficient to predict failure. A combination of ultrasonographic and diuretic scan parameters were useful for follow up and for detection of failure. The success rate in our study was 92%. Chief limitations of our study were retrospective nature and lack of comparison with pyeloplasty. Moreover, some cases were performed with minimal invasive techniques, so the study group was heterogenous.
UC offers excellent outcome in children with GH due to primary as well as secondary UPJO. Isolated ultrasonographic or diuretic renogram parameters are not sufficient to predict failure and a combination of them should be used for follow up after UC. [Display omitted]</description><subject>Adolescent</subject><subject>Child</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hydronephrosis</subject><subject>Hydronephrosis - diagnostic imaging</subject><subject>Hydronephrosis - surgery</subject><subject>Kidney - physiology</subject><subject>Kidney Pelvis</subject><subject>Kidney pelvis/ abnormalities</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Ureteral Obstruction - diagnostic imaging</subject><subject>Ureteral Obstruction - surgery</subject><subject>Urologic Surgical Procedures</subject><issn>1477-5131</issn><issn>1873-4898</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2KFTEQhYMozo--gUgvXdhtpX-StAthGBwdGBBE1yGdVN-bSzppk7Rwn8GXNtc7unRVZ_GdKk4dQl5RaChQ9u7QHNYtBte00NIGWAPAn5BLKnhX92IUT4vuOa8H2tELcpXSAaDj0I7PyUXXU874AJfk19fgsApztUXMGINWzuqQcliOlfXVorza4YI-n5idVUXsjyYGj-s-hmTTidJ760xE_0cHn3FZQ1TxWK1R6Ww1vq_uvbFaZRt8eluFLeuwYKqUN8WsnEO_w_SCPJuVS_jycV6T73cfv91-rh--fLq_vXmodcfaXCOISfRat0hp204j63o0M5hpRqEYcMXMNNJhGnoQHRMGxtaMQGFWmsLEWXdN3pz3rjH82DBludik0TnlMWxJtkM_jGIcuShof0Z1CZsiznKNdinRJAV5qkEe5LkGeapBApOlhmJ7_XhhmxY0_0x__16AD2cAS86fFqNM2qLXaGxEnaUJ9v8XfgNCHJ7C</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Ansari, M.S.</creator><creator>Danish, Nayab</creator><creator>Yadav, Priyank</creator><creator>Kaushik, Vinay N.</creator><creator>Kakoti, Shitangsu</creator><creator>Kumar, Abhay</creator><creator>Banthia, Ravi</creator><creator>Srivastava, Aneesh</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9783-0729</orcidid><orcidid>https://orcid.org/0000-0001-8723-9732</orcidid><orcidid>https://orcid.org/0000-0002-5477-0161</orcidid><orcidid>https://orcid.org/0000-0002-4180-0456</orcidid><orcidid>https://orcid.org/0000-0002-2509-0116</orcidid></search><sort><creationdate>202110</creationdate><title>Role of ureterocalicostomy in management of giant hydronephrosis in children in contemporary practice: Indications, outcomes and challenges</title><author>Ansari, M.S. ; 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The aim of this study was to investigate the role of ureterocalicostomy (UC) in unilateral GH with respect to its current indications, outcomes and the challenges associated with it.
We retrospectively analysed data of 25 children (up to the age of 18 years) who underwent UC between January 2008 and January 2019 using open, laparoscopic or robotic-assisted approach. Preoperative workup included ultrasonography for pelvic anteroposterior diameter (APD) and cortical thickness (CT), and diuretic scan for split renal function (SRF) and drainage. Patients were followed with ultrasonography and diuretic renal scan at 3 months, after further 6 month and then annually.
The median age was 7 years and median follow-up was 22 months. Eight children underwent UC as salvage procedure while 17 children underwent UC as an upfront procedure. APD declined significantly (p < 0.001) and CT improved significantly (p = 0.009) after surgery. The drainage as well as SRF did not change significantly after surgery. Four children developed flank pain after stent removal; one required a redo-ureterocalicostomy for anastomotic stricture while another required balloon dilatation of the anastomosis. Two children responded to prolonged stenting for 2 months.
Ultrasonography (APD, CT), Diuretic renal scan (SRF and drainage pattern) are used to monitor HDN. APD is particularly important in GH because the diuretic renogram invariably shows an obstructive drainage owing to the large volume of the pelvicalyceal system. Similar to previous studies in literature, we too reported a decline in APD. CT improved in our study, however, the drainage pattern as well as SRF did not change significantly (Figure). Diuretic scan in isolation was not sufficient to predict failure. A combination of ultrasonographic and diuretic scan parameters were useful for follow up and for detection of failure. The success rate in our study was 92%. Chief limitations of our study were retrospective nature and lack of comparison with pyeloplasty. Moreover, some cases were performed with minimal invasive techniques, so the study group was heterogenous.
UC offers excellent outcome in children with GH due to primary as well as secondary UPJO. Isolated ultrasonographic or diuretic renogram parameters are not sufficient to predict failure and a combination of them should be used for follow up after UC. [Display omitted]</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>34176750</pmid><doi>10.1016/j.jpurol.2021.06.007</doi><orcidid>https://orcid.org/0000-0001-9783-0729</orcidid><orcidid>https://orcid.org/0000-0001-8723-9732</orcidid><orcidid>https://orcid.org/0000-0002-5477-0161</orcidid><orcidid>https://orcid.org/0000-0002-4180-0456</orcidid><orcidid>https://orcid.org/0000-0002-2509-0116</orcidid></addata></record> |
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| subjects | Adolescent Child Follow-Up Studies Humans Hydronephrosis Hydronephrosis - diagnostic imaging Hydronephrosis - surgery Kidney - physiology Kidney Pelvis Kidney pelvis/ abnormalities Retrospective Studies Treatment Outcome Ureteral Obstruction - diagnostic imaging Ureteral Obstruction - surgery Urologic Surgical Procedures |
| title | Role of ureterocalicostomy in management of giant hydronephrosis in children in contemporary practice: Indications, outcomes and challenges |
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