Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
The Success of Pyeloplasty in Adult Patients with Ureteropelvic Junction Obstruction: A Retrospective Clinical Study
Erişkin Üreteropelvik Bileşke Darlığı Hastalarında Piyeloplastinin Başarısı: Retrospektif Klinik Çalışma
Abdullah İLKTAÇa, Cevper ERSÖZa, Bayram DOĞANa, Habib AKBULUTa, Yusuf Özlem İLBEYa
aDepartment of Urology, Bezmiâlem Vakıf University Faculty of Medicine, İstanbul, Türkiye
J Reconstr Urol. 2022;12(3):105-13
doi: 10.5336/urology.2022-92676
Article Language: EN
Full Text
ABSTRACT
 Objective: Ureteropelvic junction obstruction (UPJO) is a disease often diagnosed in childhood, but it can rarely be detected in adults. Dismembered pyeloplasty is the gold standard treatment method. In this study, we evaluated the success of pyeloplasty in adult patients with UPJO. Material and Methods: We retrospectively reviewed the data of the adult patients who underwent pyeloplasty between January 2012 and July 2021. Preoperative and postoperative differential renal function (DRF), the time required for the clearance of half of the radioisotope from the renal pelvis (T1/2), presence of symptoms, degree of hydronephrosis, anteroposterior (AP) diameter of the renal pelvis, and parenchymal thickness were compared. Results: A total of 30 patients with a mean age of 32.43±7.18 were included in the study. No statistically significant difference was detected between preoperative and postoperative mean DRF (37.6±12.08 and 38±11.35, respectively) (p=0.775). In 19 (63.33%) patients DRF remained unchanged. In 7 (23.33%) patients DRF was improved, and in 4 (13.34%) patients DRF deteriorated. The mean AP diameter and grade of hydronephrosis were significantly improved after pyeloplasty. The ratio of patients with a T1/2>20 minutes significantly decreased from 83.33% to 26.67% (p=0.001). Before the operation 26 (86.67%) patients were symptomatic. After the operation only 8 (26.67%) patients were symptomatic. This change was statistically significant (p=0.001). Conclusion: There were significant improvements in T1/2, AP diameter of the renal pelvis, and the degree of hydronephrosis. Renal function was preserved after the surgery. Also, pyeloplasty was effective in pain relief and should be recommended to adults with UPJO.

Keywords: Ureteral obstruction; adult; hydronephrosis; kidney
ÖZET
 Amaç: Üreteropelvik bileşke obstrüksiyonu (UPJO) sıklıkla çocukluk çağında tanı konulan bir hastalıktır ancak nadiren erişkin dönemde de saptanabilir. Dismembered pyeloplasti altın standart tedavi yöntemidir. Bu çalışmada, UPJO'lu erişkin hastalarda dismembered pyeloplasti operasyonunun başarısını değerlendirdik. Gereç ve Yöntemler: Ocak 2012 ile Temmuz 2021 tarihleri arasında dismembered pyeloplasti yapılan erişkin hastaların verileri geriye dönük olarak incelendi. Preoperatif ve postoperatif diferansiyel renal fonksiyon (DRF), radyoizotopun yarısının renal pelvisten temizlenmesi için gereken süre (T1/2), semptom varlığı, hidronefroz derecesi, renal pelvis anteroposterior (AP) çapı ve parankim kalınlığı karşılaştırıldı. Bulgular: Çalışmaya yaş ortalaması 32,43±7,18 olan toplam 30 hasta dâhil edildi. Ameliyat öncesi ve ameliyat sonrası ortalama DRF değerleri (sırasıyla 37,6±12,08 ve 38±11,35) arasında istatistiksel olarak anlamlı fark saptanmadı (p=0,775). DRF, 19 (%63,33) hastada değişmeden kaldı, 7 (%23,33) hastada düzeldi ve 4 (%13,34) hastada kötüleşti. Ortalama AP çapı ve hidronefroz derecesi piyeloplasti sonrası önemli ölçüde düzeldi. T1/2>20 dk olan hastaların oranı %83,33'ten %26,67'ye düştü (p=0,001). Ameliyat öncesi 26 (%86,67) hasta semptomatik iken, ameliyat sonrası sadece 8 (%26,67) hastada semptom mevcuttu. Bu değişiklik istatistiksel olarak anlamlıydı (p=0,001). Sonuç: Ameliyattan sonra T1/2'de, renal pelvis AP çapında ve hidronefroz derecesinde anlamlı iyileşmeler olduğu ve böbrek fonksiyonlarının korunduğu ortaya konuldu. Ayrıca pyeloplastinin ağrının giderilmesinde etkili bir yöntem olduğu ve UPJO'lu erişkinlere önerilmesi gerektiği sonuçlarına ulaşıldı.

Anahtar Kelimeler: Üreteral obstrüksiyon; erişkin; hidronefroz; böbrek
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