The Effect Of Integrated Diagnosis And Treatment Mode Of Prenatal Diagnosis And Postnatal Regular Follow-up On The Treatment Of Congenital Ureteropelvic Junction Obstruction In Children

Objective: A retrospective analysis was conducted on the data of children with congenital ureteropelvic junction obstruction who performed surgical treatment in our hospital in the past 6 years to study and summarize the effect of the integrated diagnosis and treatment mode of prenatal diagnosis and postnatal regular follow-up on the treatment of children with congenital hydronephrosis.Methods: The data of children with congenital ureteropelvic junction obstruction who met the inclusion and exclusion criteria from August 2013 to July 2019 were collected,including the time of admission,gender,age,whether had prenatal diagnosis,whether had regular follow-up after birth,the degree of preoperative hydronephrosis,whether associated with urinary tract infections,whether performed one-stage percutaneous nephrostomy,whether performed kidney renal resection,whether happened postoperative complications,postoperative follow-up review information.The patients were divided into management group and non-management group according to the prenatal diagnosis and postnatal regular follow-up,and the preoperative and postoperative data of the two groups were compared.The patients were divided into 6 groups according to the time of admission,and the proportion of prenatal examination,prenatal diagnosis and regular follow-up after prenatal diagnosis were compared in different years.Results: 1.General information: In this study,123 cases of congenital ureteropelvic junction obstruction met the inclusion criteria,with the minimum age of 1 month and 6 days old,with the maximum age of 14 years old,with an average age of 5.97±3.82 years old,including 90 males and 33 females,with a male-female ratio of 2.7:1,78 cases on the left,33 cases on the right,and 12 cases on both sides.Among the 123 cases,77(62.6%)cases were performed open pyeloplasty,43(35.0%)cases were performed laparoscopic pyeloplasty,3(2.4%)cases were performed nephrectomy,and 17(13.8%)cases were performed one-stage percutaneous nephrostomy.32 cases in the management group were diagnosed as hydronephrosis in the prenatal period and had postnatal urinary examination within 1 month,3 months,6 months,1 year and at least one each year thereafter.They were admitted to the hospital due to the results of follow-up examination were in line with the surgical standards,2 patients showed symptoms of abdominal pain during the follow-up,6(18.8%)cases were performed open pyeloplasty,26(81.2%)cases were performed laparoscopic dismembered pyeloplasty,and 1(3.1%)case was performed one-stage percutaneous nephrostomy.In the non-management group,there were 91 cases,among which 65 cases(71.4%)were admitted to the hospital due to the examination of ultrasound or CT diagnosed as hydronephrosis with the symptoms of lumbago,abdominal pain,abnormal urination,post-traumatic hematuria,abdominal mass,and 26 cases(28.6%)were admitted to the hospital due to accidental hydronephrosis when they were examined for other reasons.Among the 91 cases,70 cases had prenatal examination,among which 9 cases were diagnosed as hydronephrosis in fetal period,and then the postnatal examination of hydronephrosis was not increased,and follow-up was not carried out due to the absence of symptoms.In the whole group,71 cases(78.0%)were performed open pyeloplasty,17 cases(18.7%)were performed laparoscopic dismembered pyeloplasty,and 3 cases(3.3%)were performed nephrectomy,among which 16 cases(17.6%)were performed one-stage percutaneous nephrostomy.2.Comparative analysis results between the management group and non-management group :(1)The minimum age of the children in the management group was 1 month and 6 days old,the maximum age was 7 years old,and the median age was 2 years and 2 months old.The minimum age of the children in the non-management group was 1 month and 17 days old,the maximum age was 14 years old,and the median age was 7 years old.(2)The management group with mean preoperative anteroposterior renal pelvic diameter(3.03 ± 0.78)cm was less than the management group(4.27 ± 1.07)cm,mean renal cortical thickness(4.44 ± 1.27)mm was greater than the non-management group(3.41 ± 1.08)mm,mean DRF(40.45 ± 10.97)% was higher than that of the non-management group(29.49 ± 12.07)%,the preoperative percentage of DRF-1 in management group was significantly higher than that in non-management group,and the percentage of DRF-4 was lower than that in non-management group,the difference was statistically significant(P<0.05).(3)The proportion of children with preoperative urinary tract infection,urinary calculi and contralateral hydronephrosis in the management group was significantly lower than that in the non-management group,with statistically significant differences(P<0.05).(4)Among the 32 cases in the management group,1 case was performed one-stage percutaneous nephrostomy,and 1 case occurred postoperative urinary tract infection.Among the 91 patients in the non-management group,16 cases had one-stage percutaneous nephrostomy,3 cases had nephrectomy,and 17 cases had postoperative complications,including 9 cases of urinary tract infection,3 cases of urinary extravasation,2 cases of hematuria,2 cases of adhesive intestinal obstruction,and 1 case of anastomotic stenosis.The proportion of one-stage percutaneous nephrostomy and postoperative complications of the management group was significantly lower than that of the non-management group,and the difference was statistically significant(P<0.05).(5)Comparison of reexamination results at 6 months after the operation: the mean renal cortex thickness,average DRF of partial renal function and proportion of DRF-1 of partial renal function of the management group were all greater than those of the non-management group,and the mean anteroposterior renal pelvic diameter was smaller than those in the non-management group,with statistically significant differences(P<0.05).3.Results of grouping analysis of admission time: Among the 123 cases,102(82.9%)cases received prenatal examination,41 cases(33.3%)were diagnosed as hydronephrosis by prenatal ultrasound,among the 41 cases,32 cases were regularly followed up after prenatal diagnosis,and 9 cases were lost to follow-up after prenatal diagnosis.According to the grouping analysis of admission time,the proportion of prenatal examination,prenatal diagnosis,prenatal diagnosis and regular follow-up increased year by year.Conclusion: 1.The integrated diagnosis and treatment mode of prenatal diagnosis and postnatal regular follow-up can make children with congenital hydronephrosis be diagnosed and treated as soon as possible,which is conducive to the protection of renal function and postoperative recovery.2.The current diagnosis and treatment mode of congenital hydronephrosis still needs to be further optimized.