[Benefits of pyeloplasty in children with pyeloureteral stenosis: study of somatic development and differential renal function].
BACKGROUND
Under the actual controversy about the management of hydronephrosis for ureteropelvic junction obstruction, our objective has been to evaluate the indications and the effects of pyeloplasty as therapeutic option.


METHODS
We have reviewed the charts of patients who underwent pyeloplasty, in special concerns at the preoperatory study and the postoperatory control by means of differential renal function (DRF) and half-time drainage (T1/2) on curves of Tc99m MAG3 diuretic renogram, and the effects in the body growth.


RESULTS
Between 1995-1999 a total of 16 patients (17 kidneys) underwent pyeloplasty (range: 2 months to 12 years), selecting for the surgical treatment the symptomatic cases and the asymptomatics with alteration of renographic curve and/or DRF. The left side was involved in 12 cases, the right side in 3, and one case was bilateral. The malformation was detected by prenatual ultrasonography on 56.25% of cases and by several symptoms (abdominal pain, infection) in remaIns. The preoperatory DRF was normal (> or = 45%) in 53.3% and deteriorated in 46.7%. Postoperatively, global differential renal function improved significantly, with normal values in 66.7% of kidneys at first control and 75% at the second one. All the cases presented before surgery an obstructed renographic curve, with a half-time superior to 20 minutes; after pyeloplasty the excretory pattern in the diuresis renogram improved significantly, with a normal pattern (T1/2 < 10') in 54%, indeterminate (T1/2 between 11 and 20') in 26.7% and obstructive (T1/2 > 20') in 20% of cases. At the age of surgery, 29.4% of children was below the 50th percentile in weight; postoperatively, only 5.9% was, demonstrating a significant increment in all the cases.


CONCLUSIONS
Pyeloplasty is an effective technique for the treatment of ureteropelvic junction obstruction in the selected cases, demonstrating a significant of differential renal function and body growth.
Royo Cuadra
Y
Y
Servicio de Cirugía Pediátrica, Hospital Universitario Juan XXIII, C/Dr. Mallafré Guasch, 43005 Tarragona.
Maldonado Artero
J
J
Spuch Sánchez
J
J
Martín Mesonero
D
D
Danús Lainez
M
M
Siurana Escuer
R
R
Jariod Pàmies
M
M
Bardají Pascual
C
C
D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D007682:Kidney Pelvis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000503:physiopathology / Q000601:surgery*