3 Aydan küçük İnfantlarda yapılan Piyeloplasti sonuçlarımız

Abstract

Amaç: Üreteropelvik bileşke obstrüksiyonu (UPBO), genellikle antenatal dönemde tanı alan ve yaklaşık %0,1 insidansla görülen konjenital bir anomalidir. Açık dismembered pyeloplasti yüksek başarı oranları nedeniyle günümüzde altın standart yöntem olarak kabul edilmektedir. Bu çalışmada üç aydan küçük infantlarda uygulanan ‘minyatürize ekstrakorporeal dismembered pyeloplasti (MExDP) tekniğinin fonksiyonel ve postoperatif sonuçları değerlendirilmiştir. Yöntemler: Kasım 2019 - Nisan 2025 tarihleri arasında antenatal hidronefroz tanısı ile merkezimize yönlendirilen ve UPBO tanısı konularak cerrahi endikasyonu olan 58 infant retrospektif olarak incelendi. Preoperatif değerlendirmede ultrasonografi, laboratuvar analizleri ve diüretikli MAG3 sintigrafi uygulandı. Cerrahi endikasyon kriterleri arasında split renal fonksiyon <%40, parankim kalınlığı <3 mm, progresif AP çap >40 mm ve SFU evre 3-4 hidronefroz yer aldı. Tüm olgular tek cerrah tarafından 2 cm subkostal mini insizyonla opere edildi. İntraoperatif ve postoperatif bulgular kayıt altına alındı. Bulgular: Olguların yaş ortalaması 65,3 gündü (32–88). Ortalama insizyon uzunluğu 2,1 cm, ortalama operasyon süresi 65 dakika olarak belirlendi. Peroperatif olarak bir olguda retrokaval üreter, iki olguda aberran damar ve 55 olguda primer UPBO saptandı. Komplikasyon oranı %3 olup majör komplikasyon gözlenmedi. Postoperatif 3. ayda tüm olgularda hidronefroz derecesinde gerileme ve MAG3 sintigrafide drenajda düzelme izlendi. Başarı oranı %100 idi. Sonuç: MExDP tekniği, üç aydan küçük infantlarda UPBO tedavisinde güvenilir ve etkili bir yöntemdir. Daha küçük cerrahi kesi, daha az postoperatif ağrı, daha hızlı iyileşme ve üstün kozmetik sonuçlar sağlamasıyla öne çıkmaktadır. Robotik veya laparoskopik cerrahi imkanı bulunmayan merkezlerde MExDP, pratik ve uygulanabilir bir alternatif olarak değerlendirilebilir.

Keywords

• İnfant
• Piyeloplasti
• Hidronefroz

Results of Pyeloplasty in infants Under 3 Months of Age

Abstract

Objective: Ureteropelvic junction obstruction (UPJO) is a congenital anomaly most often diagnosed antenatally, with an incidence of approximately 0.1%. Open dismembered pyeloplasty remains the gold standard with high success rates. This study aimed to evaluate the functional and postoperative outcomes of miniaturized extracorporeal dismembered pyeloplasty (MExDP) in infants younger than 3 months of age. Methods: Between November 2019 and April 2025, 58 infants under 3 months of age diagnosed with UPJO and meeting surgical criteria were retrospectively analyzed. Preoperative evaluation included ultrasonography, laboratory tests, and diuretic Tc-99m MAG3 renography. Indications included split renal function <40%, parenchymal thickness <3 mm, progressive AP diameter >40 mm, and SFU grade 3–4 hydronephrosis. All surgeries were performed by a single surgeon via a 2 cm subcostal mini-incision. Intra- and postoperative parameters were recorded. Results: The mean age was 65.3 days (32–88). Mean incision length was 2.1 cm, and mean operative time was 65 minutes. Intraoperatively, one retrocaval ureter, two aberrant vessels, and 55 primary UPJO cases were identified. The complication rate was 3%, with no major complications. At 3 months follow-up, all patients demonstrated improvement in hydronephrosis and drainage on MAG3 renography, yielding a 100% success rate. Conclusions: MExDP is a safe and effective surgical option for UPJO in infants younger than 3 months, offering reduced surgical trauma, smaller cosmetic scars, and outcomes comparable to laparoscopic or robotic approaches. In centers lacking robotic or advanced laparoscopic expertise, MExDP represents a feasible alternative.

Keywords

• Infant
• Pyeloplasty
• Hydronephrosis.

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