Analysis of long-term follow-up results of conservative treatment of children with unilateral UPJO

Abstract

Objective This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis. Methods The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively. All the patients underwent non-surgical treatment. There were 67 males and 34 females. The age range is from 10 days to 10 years old, with an average age of 3.4 years. 52 cases got left side obstruction and 49 cases got the right side obstrction. 14 children had abdominal pain symptoms. Among the 37 neonates: 21 male, 16 female. 15 were left, 22 were right. 10 cases were found during prenatal pregnancy, and 27 were dignosed postpartum. The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis. The hydronephrosis did not affect the child's breathing, growth and development. The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period. The diuretic radionuclide imaging was done every 6 to 12 months. The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side. Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development, renal function reduction >10%, hydronephrosis SFU, UTDP grade progressive increase. Among them, 3 cases were raised from SFU2 to SFU3, 17 cases were raised from SFU3 to SFU4; 4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases. Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in. Results Continuous follow-up ranged from 1 year to 5 years, a median follow-up is 37 months. Of the 101 patients, 41 (40.5%) required surgery, and 60 (59.5%) kept conservative follow up. 2 cases of SFU1 children with hydronephrosis spontaneously disappeared. Of the 26 SFU class 2 children, 15 (69.2%) spontaneously resolved, 7(30.7%) improved, and 4 underwent surgery. Of the 50 children with SFU grade 3 hydronephrosis, 11(22.0%) spontaneously resolved, 19 improved or remained unchanged, and 20 patients eventually underwent surgery. Of the 23 patients with SFU grade 4 hydronephrosis, 6(26.0%) improved (to SFU 2) and 17(73.9%) underwent surgery. 37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading. Twenty-seven (70.2%) of the 37 neonates underwent conservative treat ment, including 8(100.0%) UTDP grade 1 hydronephrosis, 8(66.7%) UTDP grade 2 hydronephrosis, and UTDP grade 3 10 cases (58.8%) of hydronephrosis were effective for conservative treatment. There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy of conservative treatment. Conclusion Conservative treatment of unilateral ureteral pelvic and ureteral junction obstruction is safe and effective. Severe hydronephrosis is unlikely to spontaneously resolve, often accompanied by early loss of renal function, and should be followed closely by ultrasound. Key words: Ureteral obstruction; Ureteropelvic junction obstruction(UPJO); Urinary color Doppler; Diuretic renal scan; Follow-up