Jehangir, Susan Homi (2013) A Study to evaluate patients with pelviureteric junction obstruction who underwent dismembered pyeloplasty between January 2006 and December 2011. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Pelviureteric junction obstruction (PUJO) or Ureteropelvijunction obstruction (UPJO) is the commonest cause of hydronephrosis in children. Once obstruction has been diagnosed the surgeons main priority is to decide whether the child requires an operation. There are many controversies with respect to approach, degree of invasiveness and timing of surgery. The objective however is the same in all approaches: to preserve renal function in the least morbid manner with the best possible outcome. Anderson-Hynes dismembered pyeloplasty has been used for more than 50 years and it remains the surgical treatment of choice for paediatric PUJO. Although there have been many modification the basic operative technique for dismembered pyeloplasty is universal, involving excision of the pelviureteric junction and redundant pelvis when necessary, and re-anastomosis of the healthy ureter to the renal pelvis. The postoperative follow up of patients involves ultrasound and diuretic renal scan. This yields structural and functional assessment of the operated kidney. However since the success rates of pyeloplasty are as high as 97% it seems unnecessary to expose 100 children to ionizing radiation to find the 2 or 3 who might have postoperative obstruction. Postoperative follow up with ultrasound is being explored as a viable alternative with diuretic renal scan reserved for doubtful cases. AIMS AND OBJECTIVES - AIM : The purpose of this study was to evaluate patients with pelviureteric junction obstruction who underwent dismembered pyeloplasty between January 2006 and December 2011 in Christian Medical College and Hospital, Vellore. OBJECTIVES : 1.To analyse the presenting symptoms and their resolution after surgery. 2. To evaluate the difference between the pre and post operative split renal function and drainage patterns by renal sinctigraphy. 3. To assess if there is resolution of hydronephrosis post pyeloplasty by renal ultrasound. 4. To study the different patient profiles and assess if there is a difference in outcome in them i.e. antenatally detected, supranormal functioning, type of stent used etc. 5.To study failed pyeloplasty. CONCLUSIONS : The number of operations being performed is increasing every year. 80% are of operated children are boys and 65% affected moieties are on the left. The average age at operation is approximately 4 years. Less infants are being operated in recent years. The most common presenting complaint is pain followed by UTI and mass. The hospital stay is getting shorter especially with the use of internal stents. 96% percent of children had symptomatic relief after pyeloplasty. The commonest immediate postoperative complication is UTI. Pyeloplasty failure can occur any number of years after the initial operation. The results after redo pyeloplasty are good. The appendix may be used to replace a very unhealthy ureter but it is to be kept as a last resort. Split renal function improves marginally after pyeloplasty and cannot be a measure of successful pyeloplasty.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | pelviureteric junction obstruction ; underwent ; dismembered pyeloplasty. |
| Subjects: | MEDICAL > Paediatric Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 01 Aug 2017 03:23 |
| Last Modified: | 01 Aug 2017 08:25 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2409 |
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