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마제신에서의 신우요관이행부협착양상 |
연세대학교 의과대학 비뇨의학교실
¹국립건강보험공단 일산병원 비뇨의학과 |
| 모하메드 이브라임 엘마디, ¹강숭구, 김상운, 한상원, 이용승 |
Purpose: The cause of ureteropelvic junction obstruction (UPJO) in horseshoe kidney (HSK) has been known as abnormal crossing of the ureter over isthmus, high ureteral insertion in the renal pelvis, and crossing of multiple aberrant renal vessels over the ureter. Various surgical techniques including conventional Anderson-Hynes pyeloplasty, vascular hitch, endopyelotomy, ureterocalicostomy, and isthmotomy with kidney separation has been suggested. We retrospectively investigated the cause of obstruction in patients with UPJO in HSK.
Methods: Retrospectively we performed this study on 20 patients with UPJO and HSK underwent pyeloplasty between April 2000 and March 2020. The clinical characteristics, cause of obstruction and surgical outcomes were analyzed.
Results: The median age of operation was 4.1 (0.5-18.9) years. Pyeloplasty was performed by open, laparoscopic, and robotic technique in six, ten and 4 patients, respectively. In all cases, high insertion of ureter was found while crossing vessel was in observed in 12 patients. Preoperative and postoperative differential renal function was 38(7-53) and 45(8-55), respectively. No patient required additional surgical management.
Conclusions: Anderson-Hynes pyeloplasty was successful in UPJO patients with HSK regardless of surgical modality. As high insertion and crossing vessel are two causes of UPJO in HSK, vascular hitch, endopyelotomy, and isthmotomy with kidney separation seems improper in this condition.
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keywords : horseshoe kidney, ureteropelvic junction obstruction, pyeloplasty |
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