The algorithm of choosing the optimal treatment of hydronephrosis caused by UPJ obstruction

Abstract

Developed and introduced into clinical practice algorithm for choosing the optimal treatment of hydronephrosis caused by UPJ obstruction through open and laparoscopic piyeloplastic, balloon dilatation, endopiyelotomi and laser dissection. The study included 180 patients with hydronephrosis I–IV degree, caused by UPJ obstruction who were treated in urological departments of the State Scientific Centre «Scientific and Practicing Centre of Preventive and Clinical Medicine» on the basis of the State Affairs Governance in Kyiv and Lviv Regional Clinical Hospital during 2008–2013. To the patients used prognostic criteria according to which all of them divided into six clinical groups and used for each optimal surgical technique: group 1 – 55 patients (34%), which made an open piyeloplastic, group 2 – 46 patients (29%) in which the stricture by laparoscopic piyeloplastic, group 3 – 26 patients (16%), which made endopiyelotomi cold knife, group 4 – 17 patients (11%) which held balloon dilatation, 5 group – 13 patients (8%), which made the laser dissection UPJ obstruction, and group 6 – 4 patient (2%), who held nephrectomy. From the 157 patients for whom surgery organ made by the algorithm in 141 (89,8%) received excellent in 12 (7,6%) – satisfactory and only 4 (2,6%) unsatisfactory result. The effectiveness of open pyeloplastic was 98,%, laparoscopic pyeloplastic – 97,8% and endoscopic operations – 96,4%. Given the criteria algorithm excellent result we had in 89,8% (141 patients), satisfactory – in 7,6% (12 patients) and 2,6% (4 patients) – the result is unsatisfactory. High efficiency (97,4%) developed our algorithm, simplicity and availability to use, it allows wide use in clinical practice.