Üreteropelvik Bileşke Obstrüksiyonu Olan Çocuklarda Minimal İnvaziv Açık Piyeloplasti: Perianastomotik Drenaja İhtiyaç Var mıdır?

Abstract

Amaç: Üreteropelvik bileşke tıkanıklığı (UPJO), çocukluk çağında obstrüktif üropati veya hidronefrozun en sık görülen nedenidir. UPJO'lu çocuklarda en etkili tedavi yöntemi açık piyeloplastidir. Bu çalışmanın amacı, UPJO'u olan çocuklarda ayaktan tedavi yöntemi olarak JJ stentli ve perianastomotik dren uygulamaksızın, minimal invaziv açık piyeloplasti olasılığını sunmaktır. Yöntemler: Haziran 2007 ile Ocak 2022 tarihleri arasında üreteropelvik bileşke obstrüksiyonu nedeniyle piyeloplasti geçiren, ortanca yaşı ve çeyreklik aralık (IQR) 3 (7) yıl olan 46 çocukta retrospektif bir değerlendirme yapıldı. Yaş, cinsiyet, görüntüleme yöntemleri, cerrahi teknikler, transanastomotik stent, drenaj uygulamaları, komplikasyonlar ve hastanede kalış süresi kaydedildi. Ameliyat öncesi çalışmalar ultrasonografi (USG), diüretik reno-grafi ve manyetik rezonans ürografiyi (MRU) içeriyordu. Ameliyat endikasyonları USG'de artan hidronefroz derecesi, %40'tan az diferansiyel böbrek fonksiyonu ve seri böbrek sintigrafisinde %10'dan fazla fonksiyonel kayıp olarak tanımlanan önemli obstrüksiyondu. Minimal invaziv açık pyeloplasti, pelvik redüksiyon uygulanmadan, kaslar mini flank insizyonu ile ayrılarak retroperitoneal olarak gerçekleştirildi. Trans-anastomotik JJ stent uygulanırken perianastomotik dren kullanılmadı. Bulgular: Açık pyeloplasti ve minimal invaziv açık pyeloplasti sırasıyla 15 ve 31 [33 renal ünite (RU)] olguda gerçekleştirildi. Ortanca hastanede kalış süresi (IQR) 15 olguda 120 (48) saat iken, JJ stentli ve perianastomotik dren uygulanmayan minimal invaziv açık pyeloplasti uygulanan 31 olguda bu süre 22 (5) saatti (P < ,01). Bu 31 olgunun 24'ü 24 saatten (ortalama 21 saat) önce taburcu edildi. Tüm hastalara çoklu USG ve diüretikli renografi yapılırken, 28 hastaya sadece bir MRU uygulandı. USG ile MRU arasında pozitif anlamlı korelasyon bulundu. Sonuç: Üreteropelvik bileşke obstrüksiyonu olan çocuklarda perianastomotik dren olmadan JJ stentli minimal invaziv açık piyeloplastinin ayaktan tedavi yöntemi olarak güvenle uygulanabileceğini öneriyoruz.

Keywords

• Çocuklar
• JJ stent
• hidronefroz
• açık piyeloplasti
• üreteropelvik bileşke obstrüksiyonu

Minimally Invasive Open Pyeloplasty in Children with Ureteropelvic Junction Obstruc-tion: Is There a Need for a Perianastomotic Drain?

Abstract

Objective: Ureteropelvic junction obstruction (UPJO) is the most common cause of obstructive uropathy or hydronephrosis in childhood. The most effective treatment for children with UPJO is open pyeloplasty. The purpose of this study was to present the possibility of minimally invasive open pyeloplasty with a double-J stent and without a perianastomotic drain as an outpatient procedure in children with UPJO. Methods: A retrospective evaluation was performed in 46 children with a median age (IQR) of 3 (7) years who underwent pyeloplasty for UPJO between June 2007 and January 2022. Age, gender, imaging studies, surgical techniques, trans-anastomotic stent, drain applications, complications, and length of hospital stay were noted. Pre-operative studies included ultrasonography (USG), diuretic renography, and magnetic resonance urography (MRU). Indications for surgery were an increasing degree of hydronephrosis on USG, less than 40% differential renal function, and significant obstruction defined as more than 10% functional loss on serial renal scintigraphy. Minimally invasive open pyeloplasty was performed retroperitoneally by separating the muscles with a mini flank incision without pelvic reduction. No perianastomotic drain was used when the trans-anastomotic double-J stent was applied. Results: Open pyeloplasty and minimally invasive open pyeloplasty were performed in 15 and 31 [33 renal units (RU)] cases, respectively. The median hospital stay (IQR) was 120 (48) hours in 15 cases, while this period was 22 (5) hours in 31 cases that underwent minimally invasive open pyeloplasty with a double-J stent and without a peri-anastomotic drain (P<.01). Of 31 cases, 24 were discharged after <24 (mean 21 hours) hours. All patients underwent multiple USG and diuretic renography, while 28 pati-ents underwent only one MRU. A significant positive correlation was found between USG and MRU. Conclusion: We suggest that minimally invasive open pyeloplasty with a double-J stent and without a perianastomotic drain can be safely performed as an outpatient procedure in children with UPJO.

Keywords

• Children
• double-J stent
• hydronephrosis
• open pyeloplasty
• ureteropelvic junction obstruction

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