European Journal of Cardiovascular Medicine

Uretero-pelvic junction obstruction is being diagnosed more frequently than in the past largely secondary to improved prenatal detection.The natural history of hydronephrosis secondary to pelvi-ureteric junction obstruction varies. High grade obstruction results in hydrostatic distension of renal pelvis, increased intrapelvic pressure and ultimately results in irreversible renal damage with increasing duration. In low grade obstruction, the developing kidney may remain in homeostatic state without much renal damage. Between the two extremes raises the debate and the question when to perform pyeloplasty for better renal functional outcome. In this study, we have collected the data of all children with case sheets. attempted to measure Differential renal function by renal scintigraphy and by renal USG. We have total 37 puj obstruction cases from January 21 to December 2023. There are 3 cases of Crossed lower pole vessels obstructing the pelvi ureteric junction, Two cases of bilateral puj obstruction, one male child had malrotated kidney with hilum facing posteriorly and one case with mcd kidney.

AIM: To collect the data and evaluate the functional outcome in children with unilateral pelvi ureteric junction obstruction who underwent Anderson Hynes pyeloplasty between January 2021 to July 2023 .

OBJECTIVES: To analyse the clinical presentation of pelvi ureteric junction obstruction.To evaluate difference between pre and post op Differential renal function by renal scintigraphy and to assess the resolution of hydronephrosis after pyeloplasty by renal ultrasound.

Standard dismembered Pyeloplasty was done in all children, dj stent was kept. Nephrostomy tube was not kept. In the follow-up period ultrasonogram (USG) was done at 3 months, 6months and one  year. Renal scintigraphy was done with standard Technetium 99 DTPA and with frusemide at 20 mts and split renal function (SRF) was calculated at 6 months and one year. This is a Retrospective study of children who underwent Anderson Hynes Pyeloplasty in department of Paediatric Surgery, Government General Hospital, Guntur between January 2021 to December 2023.

All children who underwent Anderson Hynes Pyeloplasty for unilateral pelviureteric junction obstruction, in Government General Hospital, Guntur from January 2021 to June 2023 and follow-up till December 2023.

Inclusion Criteria:

All patients under the age of 12 years with Hydronephrosis due to unilateral Pelvi-ureteric junction obstruction without any other urological disorders are included in the study.Total number of 25 patients were studied.

Exclusion Criteria:

All patients with  Hydronephrosis other than congenital PUJ obstruction and associated other urological abnormalities are excluded. All patients with secondary Hydronephrosis, redo operations are excluded.

METHODS

Patients were identified from the Hospital records. Patients who underwent Anderson Hynes Pyeloplasty for unilateral puj obstruction were identified, investigative profile, renal ultrasonogram, renal scintigraphy and operative records were reviewed and data was analysed. All patients were evaluated preoperatively with Ultrasonogram, Renal scintigraphy (diuretic renogram) and confirm Pelvi-ureteric junction obstruction and split renal function was assessed. Standard Anderson-Hyenes Pyeloplasty was done, transanastamotic stent (dj) was kept.

Post operative ultra sound KUB was done at 3 months, 6 months and one year. Diuretic renogram and Split Renal Function (SRF) was done at 6 months and one year follow up and parametres analysed were drainage curve and differential renal function.

AGE DISTRIBUTION AMONG PATIENTS

In the present study, Infants are 36%(9), Toddlers are 12%(3), Preschool children are 12%(3) and school age children are 40% (10).

SEX DISTRIBUTION AMONG PATIENTS

In the study, 84 %  (21) are male children and only 16 %  (4) are female children.

CLINICAL PRESENTATION

Out of 25 children studied, Left kidney is affected in 64% (16) children and Right kidney is affected in 36% (9).

Out of 25 children studied, 15 children are antenatally detected, 10 children are symptomatic with episodic flank pain and among these 10 children 3 children are also having urinary tract infection at presentation.

ANALYSIS OF ANTERO POSTERIOR DIAMETRE OF AFFECTED RENAL PELVIS

Out of 25 children, the average AP diameter of diseased renal pelvis is 2.8cm and most of the children ranged from 2 to 4 cm.

Post operatively AP diameter of renal pelvis has reduced to mean value of 0.99 cm. Most of the  children have AP diameter of less than 1 cm at 6 month follow up

ANALYSIS OF DIFFERENTIAL RENAL FUNCTION ON RADIONUCLEIDE SCAN

The mean value of differential renal function in affected kidney pre operatively was 37.8% which has improved by 6.2% to 44 % post operatively.

In the present study, majority of the children are male individuals ^2,3 and majority of the patients had left sided disease. Most of the children are antenatally detected cases presented to opd at new born period or infancy and are asymptomatic which is comparable with literature². Symptomatic children are toddlers and school going children and most of these children presented with episodic flank pain on effected side. Out of these symptomatic children, 3 children are having urinary tract infection. Majority of children have narrowed adynamic ureteric segment.

The antero-posterior diameter (APD) of affected renal pelvis has been reduced in size by 6 months post operative period. Differential renal function also improved after Pyeloplasty, when compared to preoperative study by mean of 6.2 % increased split renal function. Post operatively only 3 children had urinary tract infection and these children are subjected to early stent (DJ) removal. All these 3 children are symptomatic children with flank pain and with urinary tract infection pre operatively and were treated with intravenous antibiotics for urinary tract infection pre operatively. A study by R Subramaniam et al⁶ had concluded that improvement in renal function and anteroposterior diameter of pelvis is inversely related. These kidneys would have recovered more function if there had been an earlier surgical intervention. All the children had relieved obstruction in follow up renal nuclide scan.

With the advent of fetal ultrasonogram, Hydronephrosis is diagnosed early and renal scintigraphy helps in early detection and obstructive pattern in pelvi-ureteric junction obstruction. Early intervention in obstructive pattern helps in preserving and even improving renal function.

1. GaughfNW, Smith PL, Williams DA. Faculty and student perceptions of academic counselling services at an academic health science centre. Perspect Med Educ 2013;2:16570. 
2. SupeAN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998;44:16. 
3. Burk DT, Bender DJ. Use and perceived effectiveness of student support services in afirst-yeardental student population. J Dent Educ 2005;69:114860. 
4. SukhlechaA. Academic counselling for undergraduate medical students of pharmacology. Med Educ 2010;44:492. 
5. Mandal A, Ghosh A,SenguptaG, Bera T, Das N, Mukherjee S. Factors affecting the performance of undergraduate medical students: A perspective. Indian J Community Med 2012;37:1269.
6. Catton P, Hutcheson H, Rothman A. An academic difficulty in postgraduate medical education: Results of remedial progress atUniversityof Toronto. Ann RCPSC 2002; 35:2327.
7. Deane RP, Murphy DJ. Student attendance and academic performancein undergraduate obstetrics/gynaecologyclinical rotations. JAMA. 2013;310(21):2282–8.
8. SangeetaM, Varalakshmi KL. Association between class attendance and internal assessment marks in anatomy. Indian J Clin Anat Physiol. 2019;6(1):38–40.
9. MohananLK, Harichandran DT, Vijayan SM. Association of class attendance and academic performance of MBBS students in pharmacology - A retrospective cohort study. Natl J PhysiolPharm Pharmacol. 2017;7(10):1056–60.
10. SubramaniamBS, Hande S, Komattil R. Attendance and achievement in medicine: Investigating the impact of attendance policies on academic performance of medical students. Ann Med Health Sci Res. 2013;3(2):202-5. 
11. M,Asmar A, Kibble JD. Relationship between classroom attendance and examination performance in a second-year medical pathophysiology class. Adv Physiol Educ. 2018;42(4):593–8.
12. Deane RP, Murphy DJ. Student attendance andacademic performance in Undergraduate Obstetrics/Gynecology Clinical Rotations. JAMA. 2013;310(21):2282–8.
13. CohallDH, Skeete D. The impact of an attendance policy on the academic performance of first-year medical students taking the fundamental of Disease and treatment course. CarribeanTeaching Sch. 2012;2(2):115–23.
14. HAShenawi R Yaghan A Almarabheh N AlShenawi The relationship between attendance and academic performance of undergraduate medical students during surgical clerkshipBMCMed Educ2021211396
15. RCGoyal S Choudhari SR Tankhiwale Assessment of Competency BasedMedical Internship Training with ‘Cumulative Grade Points Average System’-An Innovative Steptowards Meeting ‘Vision 2015’ of Medical Council of IndiaIndian J Public Health Res Dev20189815562.