Evaluation of pyeloplasty among children with pelvouretric junction stenosis at French Medical Institute for Mothers and Children, Kabul, Afghanistan
Date of Award
Diploma in Paediatric Surgery
Homayon Atiq Qairatmal
Abdul Jalil Wardak
French Medical Institute for Children (FMIC)
Introduction: PUJO is one the most common pathology in paediatric urology. It is the most common cause of Hydronephrosis that may progress to irreversible damage to the kidney if not resolved.
Aim: The study is to evaluate outcome of pyeloplasty and find out the association of demographic characteristics and clinical factor on outcome of pyeloplasty among children at FMIC, Kabul, Afghanistan.
Methodology: A hospital based retrospective Case Series study design was conducted at French Medical Institute for Mothers and Children, Kabul, Afghanistan. Records of 150 participants who were admitted at surgery department under diagnosis of UPJO reviewed from first January, 2010 till last December 2015, among them 110 patients based on inclusion and exclusion criteria enrolled in the study. Chi square, one way ANOVA and paired t- test were run to determine the association of factors with outcome of Pyeloplasty.
Results: Our study findings have identified that among 110 patients, 90 (88.1%) were males. Most of patients had problem on left side 79 (71.8%), right kidney in 23 (20.9%) and bilateral involvement in 8 (7.3%), all except one who diagnosed prenatally were diagnosed in postnatal period. The diagnostic tools used in this study were US and IVU. The most common complaints reported were flank pain 45.5%. Around 9 (8%) of patients had associated anomaly; most common obstructive cause were narrow ureter 86 (78.1%). Urinary tract infection was identified in 13 (11.8) patients. Hydronephrosis grading was according SFU grading system as Grade 1 (1) grade 2 (13) Grade 3 (58) and grade 4 (44) patients. Out of 110 patients, 90 had undergone Pyeloplasty procedure, while 20 patients with complete destroyed kidney had undergone nephrectomy. Patients were divided into two groups (< 2 years and > 2 years) according to their age. The follow up modality were US parameters (anteroposterior diameter of pelvis and percentage of improvement in pelvis diameter. PI more than 15 was considered as successful outcome. The overall success rate of Pyeloplasty procedure was 82%. This study revealed the factors that affect the outcome of Pyeloplasty included: degree of hydronephrosis before operation and presence or absence of UTI.
Conclusion: UPJO is one of the most common pathology in paediatric urology; in chronic case, it may progress to irreversible damage of kidneys, Aarly operation causes better outcome, as this study finds out, it improves the renal function, which approved this finding by improved in creatinine clearance level. Perusing international literature we found that US is enough for evaluating the result of pyeloplasty. The success rate of pyeloplasty at fourth month post-operative is 82% in this series, which is remarkably good. UTI and degree of hydronephrosis before operation were important factors which can affect the outcome.
Saie, Y. (2017). Evaluation of pyeloplasty among children with pelvouretric junction stenosis at French Medical Institute for Mothers and Children, Kabul, Afghanistan (Unpublished doctoral thesis). FMIC, Kabul, Afghanistan.