Thesis (Ph.D)-Cairo University, 2024.

Bibliography: pages 56-63.

Background: Pelvi-ureteric junction obstruction (PUJO) is the most common cause of Antenatal hydronephrosis (ANH). Dismembered pyeloplasty (Anderson Hynes) is considered the treatment of choice for PUJO. Following the anteroposterior diameter (APD) and parenchymal thickness (PT) post -operatively give an indication of the success of surgery. Kidneys with hugely dilated renal pelvis in pediatric population may be preserved by early pyeloplasty instead of nephrectomy with considerably longer follow-up period and complication rates.
Objectives: the aim of this study was to compare the outcome of pyeloplasty in PUJO in hugely dilated renal pelvis with non hugely dilated pelvis.
Subject and methods: A prospective comparative study was done at Abo ElReesh pediatric hospital, Cairo University between June 2016 and April 2018. Forty-three patients with 46 renal units were divided into 2 groups; group 1 included 23 with non-hugely dilated renal pelvis and group 2 included 20 patients with 23 renal units had hugely dilated renal pelvis due to PUJO. All patients underwent dismembered pyeloplasty in Abo ElReesh pediatric hospital and followed up with measuring APD and PT at 6 and 12 months post-operative.
Results: The mean preoperative APD in the group 1 was 36.1±8.7 mm, the mean preoperative PT was 6.7±2.43mm and the mean GFR was 35.6±17.3 ml/min while for group 2 APD was 65.5±13 mm (ranged from 51mm to 97mm); the mean preoperative PT was 5.56±2.43 mm, while the mean GFR was 31.4±12.1 ml/min. Anderson-Hynes pyeloplasty was done for all patients and postoperative US evaluation was performed at 6th and 12th month. At 12 month postoperative APD decreased in both groups to be 5.3±2.8mm and 29.1±10mm for group 1 and 2, respectively (p<0.01). while PT increased to 9.8±1.3mm and 9.5±2.5mm for group 1 and 2, respectively (p=0.081). Success rate was higher in group 1 in comparison to group 2 100% vs 77%. 3 Redo pyeloplasty and 2 nephrectomy cases were reported in group 2.
Conclusion: pyeloplasty is a safe and doable for preserving the function of kidneys with hugely dilated renal pelvis and improving post-operative APD and PT with more complication rates in the hugely dilated group.

لا تزال عملية تجميل حوض الكلى لاصلاح ضيق الحوض الكلوي المتضخم بشكل كبيرفى الاطفال تمثل تحديًا. تعتبر العملية ناجحة عندما ينتج عنها تخفيف الأعراض وزيادة سمك نسيج الكلى؛ ومع ذلك ، فإن بعض وحدات الكلى لن تظهر تحسنا بعد الجراحة. الأمر الأكثر أهمية هو تحديد الأطفال الذين يحتاجون إلى جراحة اخرى للانسداد المتكرر خلال فترة المتابعة ، لتجنب استئصال الكلى. على الرغم من التحدي ، إلا أن جراحة اصلاح حوض الكلى المتوسع بشكل كبيرفى الاطفال ممكنة مع معدل نجاح مرتفع. الدرجات المتغيرة من ارتجاع الكلية وضعف التصريف بعد الجراحة ليس من غير المألوف. أفضل طريقة لتقليل الانسداد هي انخفاض القطر الأمامي الخلفي وزيادة سمك نسيج الكلى على الموجات فوق الصوتية بعد الجراحة أثناء فترة المتابعة واستقرار وظائف الكلى التفاضلية في التصوير الكلوي لمدر البول . نادرا ما يحتاج الطفل إلى استئصال الكلية في الحالات التي تعاني من تدهور شديد في وظائف الكلى.

Issues also as CD.

Text in English and abstract in Arabic & English.