Surgical timing for ureteropelvic junction obstruction complicated with upper urinary tract infection in children

Abstract

Objective To investigate the effects of different surgical timing on perioperative basic conditions and complications and surgical outcomes in children suffering from ureteropelvic junction obstruction (UPJO) complicated with upper urinary tract infection. Methods A retrospective cohort study was adopted. Then clinical data of 46 UPJO children with upper urinary tract infection treated in our hospital from January 2010 to December 2020. According to the time from infection controlled to operation, they were divided into early operation group (≤1 week, n=30) and delayed operation group (≥2 months, n=16). The perioperative basic conditions (operation time, intraoperative bleeding volume, and postoperative stay) and complications (fever, lumbago, bloating, hematuria, hypertension, urinary extravasation, and urinary tract infection) and surgical outcomes (hydronephrosis, renal cortical changes, and reoperation within 6 months postoperatively) were compared between the 2 groups. Results There were no significant differences in perioperative basic conditions and complications and reoperation between the early and delayed operation groups. Postoperative hydronephrosis was greatly improved in both groups compared with the condition before operation (P < 0.001), and better improvement was obtained in the delayed operation group than the early operation group, though no statistical difference (P=0.183). The thickness of renal parenchyma was improved in 28 cases (93.3%) in the early operation group and 10 cases (62.5%) in the delayed operation group, with obvious difference between them (P=0.026). Conclusion Early or delayed pyeloureteroplasty for UPJO complicated with infection in children have no significant effects on perioperative basic conditions, complications and reoperation. Delayed operation obtains slightly better improvement of hydronephrosis, but worse improvement in renal parenchyma thickness when compared with early operation. It is suggested that early removal for obstruction is helpful to the recovery of renal parenchyma so as to avoid further renal injury.

Keywords

• ureteropelvic junction obstruction
• upper urinary tract infection
• surgical timing
• children