IP09-06?CLINICAL SIGNIFICANCE AND PROGNOSIS OF LOWER POLE HYDRONEPHROSIS FOLLOWING PROXIMAL URETEROURETEROSTOMY IN PEDIATRIC PATIENTS WITH DUPLEX SYSTEM

초록

INTRODUCTION AND OBJECTIVE: Proximal ureteroureterostomy or ureteropyelostomy is a surgical approach that aims to preserve upper pole function in pediatric patients with a duplex system associated with ectopic ureterocele or ectopic ureter. However, postoperative concerns remain regarding the potential compromise of lower pole kidney function, particularly due to anastomosis-related edema or yoyo reflux. This study aims to evaluate the clinical implications of lower pole hydronephrosis that either worsens or newly manifests following proximal ureteroureterostomy. METHODS: A retrospective analysis was conducted on a total of 178 patients who underwent proximal ureteroureterostomy for duplex system before the age of 10, from January 2005 to December 2017. The presence and severity of hydronephrosis in the lower pole were compared between preoperative and postoperative ultrasound examinations conducted at 3-6 weeks after surgery. Patients were divided into two groups: a "worsening group," which included those with new or worsened hydronephrosis, and a "non-worsening group." Clinical indicators were then compared between the two groups. For split renal function, an analysis was performed on 156 patients who were able to be followed up with a DMSA nuclear medicine scan after surgery. RESULTS: The worsening group included 62 patients (35.8%), while the non-worsening group consisted of 111 patients (64.2%). Among the worsening group, 36 patients (58.1%) had no hydronephrosis in the lower pole preoperatively, but postoperatively, 33 of these patients (91.7%) developed Grade 1-2 hydronephrosis, and 3 patients (8.3%) experienced progression to Grade 3 hydronephrosis. Of the worsening group, 56 patients underwent ultrasound follow-up 4-8 months after surgery, and improvement was observed in 55 patients (98.2%). Three patients (1.7%) from the entire cohort required reoperation due to worsening hydronephrosis in the lower pole. There were no significant differences be