Surgical treatment of children with recurrent hydronephrosis

Abstract

Introduction. Hydronephrosis is a common form of kidney pathology in children. Despite the early diagnosis and optimistic results of surgical treatment of the obstruction of the pyelourethral segment, which reach 98% in children, a group of patients with recurrent hydronephrosis is forming, which requires the development of optimal tactics for its surgical treatment. Aim: to determine the effectiveness of various methods of surgical treatment of recurrent hydronephrosis in children. Materials and methods. Seventy one patient with recurrent hydronephrosis was observed in the Department of pediatric urology-andrology. The age of the patients ranged from 6 months to 17 years. In 36 patients of the main group, the treatment of recurrent hydronephrosis was carried out according to the author’s algorithm. In 35 patients of the comparison group, treatment was carried out using traditional methods before the introduction of the algorithm into practice. Results. Recurrence of hydronephrosis in children was diagnosed within 1 to 28 months after initial surgical treatment for obstruction of the pyelourethral segment. The cause of recurrent hydronephrosis in 47 patients was stricture of the pelvic ureteral segment, an aberrant vessel was detected in 5 patients, and in 9 patients a pronounced bend of the ureter in the pyelourethral segment was determined due to compression by the lower pole of the kidney. A combination of several causes of recurrent hydronephrosis was noted in 10 patients. In patients with recurrent hydronephrosis, whose treatment was carried out according to the author’s algorithm, a less pronounced scarring process and a shorter length of ureteral stricture were revealed, as well as a shorter period of hospital stay than in patients treated without taking into account the developed algorithm. In patients treated according to the author’s algorithm, a positive result was achieved in 93%, and in patients of the comparison group — in 88% of cases. Conclusion. To increase the effectiveness of surgical treatment of children with recurrent hydronephrosis, an integrated approach is needed, choosing the optimal tactics of surgical treatment.