Effectiveness of different correction methods of pyeloureteral segment according to the data of diuretic ultrasonography
Authors: D. Z. Vorobets
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Methods of estimation of effectiveness of the open and laparoscopic pyeloplasty, as well as endo-urological palliative methods – laser resection, balloon dilatation and endopyelotomy, which determine the anatomical and functional peculiarities of renal pelvis and pyelo-ureteral junction with the help of ultrasound diagnostics during the forced diuresis, have been proposed. Changes of the area of renal pelvis, the velocity of post-furosemide increase of the scope of renal pelvis, rate of its drainage, changes in the diameter of pyeloureteral junction have been studied. This methodical approach is non-invasive, informative and simple in application. It is shown that dispersions of samples of patients after the open surgery do not differ from the dispersions of samples of the same patients before the operation on such parameters as areas of renal pelvis before the induction of furosemide, areas of renal pelvis after 15 minutes administration of furosemide, the rate of drainage after furosemide, the original diameter of pyeloureteral junction. This may indicate the stability of surgery results. For example, the larger renal pelvis by kidney size before the operation corresponded to the larger designed pelvis after the operation; renal pelvis drained faster before the operation, features faster drainage after the operation as well. Variation in the areas of renal pelvis which decreased in 40 minutes after furosemide, percent rate of longitudinal pelvis area, rate of after-furosemide increase in pelvis area, diameter of pyeloureteral junction in 15 minutes administration of furosemide after the open pyeloplasty was significantly different compared to the variation in the same parameter for the same patients before the operations. More substantial difference was observed in the same patients before and after Anderson-Hynes surgery by parameters of relative rate of after-furosemide drainage of pelvis and increase in diameter of pyeloureteral junction after 15 min administration of furosemide. That is, the same principle of operation provides similar results by anatomical parameters, such as size and diameter of pyeloureteral junction, but quite different results by functional parameters which reflect the possibility of draining of kidney in forced diuresis. Successful open pyeloplasty leads to a significant decrease in the pelvis area at different time intervals after furosemide administration, the relative increase in the pelvis area on the background of the induction of diuresis, rate of pelvis drainage, increase (normalization) in diameter of pyeloureteral junction, including the larger (better) gap of pyeloureteral junction after administration of diuretic. Concerning laparoscopic pyeloplasty, the dispersion of mean values of S, SPR, Vpr, V, VOT, D, DD after the operation was significantly different from those before the operation. This means that as in the case with open surgery, satisfactory clinical results such as reduction in renal pelvis and restoring the passage of urine through sufficient diameter pyeloureteral junction after laparoscopic pyeloplasty lead nevertheless to significant differences in the digital parameters during the objectification of operation effect by means of diuretic ultrasonography using furosemide-induced diuresis. Endoscopic surgery such as laser resection, endopyelotomy and balloon dilatation stably provides similar results (equal variances) by such parameters as pelvis area, which decreases in 40 min after furosemide administration, formation of the wide enough diameter of pyeloureteral junction and its minor fluctuations with the diuretic load. The decrease to normal parameters of all planes of renal pelvis (both before and after loading) and significant improvement of pelvis drainage (parameters responsible for the functional state of kidneys and pyeloureteral junction) indicate the success of palliative surgery in elimination of the narrowing of pyeloureteral junction.