علاج انسداد الوصل الحالبي الحوضي مع وظيفة كلوية تفاضلية أكبر من 40% على MAG3، وقطر أمامي خلفي لا يتجاوز 20 ملم، وغياب الألم والتهاب المسالك البولية

References

DOI: 10.1016/j.eursup.2012.01.004

• Conservative treatment measures, therefore, can be used if the differential renal function of the obstructed kidney is >40% and the APD is <12 mm.
• Some indications for surgery include <40% differential function of the hydronephrotic kidney on MAG3 scanning, a >20-mm anterior-posterior diameter of the renal pelvis on ultrasonographic scan, pain, and infection.
• Pyeloplasty, the gold standard treatment of a UPJO, may be a dismembered Anderson-Hynes, Culp, or Foley Y-V pyeloplasty.
• This treatment can be used in long strictures, in severe hydronephrosis, or in the presence of crossing vessels.
• Laparoscopic pyeloplasty (retroperitoneal or intraperitoneal) is technically challenging in children and has a 95% success rate in the best hands.
• Pyeloplasty also can be performed robotically.
• If drainage from the kidney is normal on a renogram at 1 yr, patients may be discharged from further follow-up.
• A renal ultrasonographic scan is obtained 6 wk after pyeloplasty or after stent removal to ensure that the hydronephrosis is resolving.