Surgical decision of concomitant ureteropelvic junction obstruction with congenital abnormalities of the kidney

Objective To investigate the timing and scheme of surgical treatment for the concomitant ureteropelvic junction obstruction(UPJO) and congenital abnormalities of the kidney. Methods The clinical data of 155 patients with concomitant UPJO and congenital abnormalities of the kidney from January 2006 to January 2016 was retrospectively analyzed. There were 107 males and 48 females, who aged 6 months to 16 years and 6 months. The average time was 5 years and 9 months old when they received operation. There were 8 cases less than 1 year old. There were 93 cases of UPJO on the left side, 54 cases on the right side, and 8 cases on both sides. There were 33 cases with duplication of kidney, 19 cases with solitary kidney, and 6 cases with renal dysplasia, 6 cases with renal ectopia, 12 cases with polycystic kidney disease, and 41 cases with dysplasia; 2 cases with renal malrotation. There were 100 cases with symptoms such as fever, abdominal pain, vomiting. 5 cases had received Anderson-Hynes pyeloplasty in other hospitals, 2 cases received nephrectomy with symptoms did not relieve. 4 cases were treated with nephrostomy in other hospital. Children with the repeated clinical symptoms, or renal function decreased significantly, or hydronephrosis progressive to the anteroposterior diameter of more than 30 mm received surgical treatment. Results There were 140 cases received Anderson-Hynes pyeloplasty, and 8 cases received nephrectomy with 5 cases were UPJO side and 3 cases were only abnormalities of the kidney without UPJO. All patients received IVP or ultrasonography postoperative 3-6 months, which showed hydronephrosis improved or no obvious change, and 4 cases were improved obviously. The IVP results showed that 5 patients with renal dysplasia together with UPJO had the renal function improved. There were 128 cases followed up for 12 to 106 months, with an average of 64.5 months. All patients had no clinical symptoms. 83 cases were re-examined by IVP or ultrasonography, and hydronephrosis was getting better or no change. Conclusions The patients with concomitant UPJO and congenital abnormalities of the kidney don′t need surgery in advance. The best choice for those patients is Anderson-Hynes pyeloplasty. The indication of nephrectomy should be considered carefully. Key words: Abnormalities of the kidney; Ureteropelvic junction obstruction(UPJO); Anderson-Hynes pyeloplasty; Nephrectomy