The Rating System of Urodynamics Upper Urinary Tract in Children under Three Years Old with Congenital Hydronephrosis

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Abstract


Background. One of the main reasons for the incorrect differentiation of obstructive and non-obstructive disorders of the upper urinary tract (UUT) is age-related morphofunctional immaturity of the kidney and its structures in children of the first three years of life. Aims — to investigate to determine the peculiarities of urodynamic disorders of the UUT in infants with congenital hydronephrosis using diuretic pyeloehography (DРG) method. Methods. There were studied DPG data of 55 patients aged 3–36 months with unilateral hydronephrosis of I–III grades SFU, which were divided into groups in accordance with the variant of violation of the urodynamics of the UUT (obstructive, obstructive-hypertensive and disadaptive). The variants established according to the parameters of the DPG (transient coefficient PUJ (Kpus), the coefficients of postfurosemide adaptation (Ka) and the efficiency of emptying (Ko) pelvis). The obtained data are compared with the conclusions of morphometric studies of the operated 20 children with ureteropelvic junction obstruction (UPJO). Results. The obstructive-hypertensive variant was determined in 18 patients, obstructive — in 20, and disadaptive — in 17. The severity of pelvic dysfunction (according to Ka and Ko) did not correlated to the grade of UPJO (according Kpus) in most cases. Intergroup and intragroup variability in the values of the DРG coefficients is confirmed by the results of PUJ and pelvis morphometry. The correlation between hystological modification in the pelvis and DPG parameters was revealed. Obtained data allowed to introduce a new indicator — urodynamic indicator of quantitative assessment of functional insufficiency of the UUT. And the score gradation of each DРG coefficient (from 0 to 4 points) in accordance with deviation from the reference values was developed. The total indicator functional insufficiency is expressed by the sum of points (SP) for each coefficient (Ka, Ko, Kpus). When SP is less than 3 points — light, 4–6 — moderate, 7–9 — expressed and 10–12 — severe grade of violation of urodynamics. The severity of dysfunctions of the UUT in 88% of children (n = 15) with a disadaptive variant corresponded to light degree, in 75% of patients (n = 14) with an obstructive-hypertensive variant — expressed (50%) and severe (25%) grades. Moderate degree of dysfunction revealed in 65% of patients (n = 13) with an obstructive variant. Conclusion. The severity of urodynamic dysfunction of the UUT in this age group can be determined by the score gradation of the DPG parameters which reflects the functionality of the pelvis/PUJ and the grade of their violation adaptive reactions in response to diuretic.


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About the authors

V. V. Rostovskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: rostovskaya_vera@mail.ru
ORCID iD: 0000-0002-3718-8911
SPIN-code: 6989-5041

Russian Federation, Moscow

MD, PhD, Professor

N. А. Кhvatynets

G.N. Speransky City Children’s Hospital No. 9

Email: dr.khvatynets@mail.ru
ORCID iD: 0000-0002-9007-6265
SPIN-code: 9082-7118

Russian Federation, Moscow

MD

G. I. Kuzovleva

G.N. Speransky City Children’s Hospital No. 9

Email: dr.gala@mail.ru
ORCID iD: 0000-0002-5957-7037
SPIN-code: 7990-4317

Russian Federation, Moscow

MD, PhD

К. М. Matyushina

G.N. Speransky City Children’s Hospital No. 9

Email: alladel@mail.ru
ORCID iD: 0000-0001-6806-8560
SPIN-code: 4922-8638

Russian Federation, Moscow

MD, PhD

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Supplementary files

Supplementary Files Action
1.
Рис. 1. Пример кривой наполнение–опорожнение лоханки при обструктивно-гипертензионном варианте уродинамики (Ка = 0,68; Ко = 0,15; Kpus = 0,11)

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2.
Рис. 2. Пример кривой наполнение–опорожнение лоханки при обструктивном варианте уродинамики (Ка = 4,05; Ко = 0,13; Кpus = 0,72)

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3.
Рис. 3. Пример кривой наполнение–опорожнение лоханки при дезадаптационном варианте уродинамики (Ка = 8,35; Ко = 0,51; Кpus = 2,23)

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4.
Рис. 4. Соотношение средних значений коэффициентов диуретической пиелоэхографии при разных вариантах нарушения уродинамики верхних мочевых путей

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5.
Рис. 5. Прирост исходного объема лоханки (∆Vn) на фоне форсированного диуреза при разных вариантах нарушения уродинамики верхних мочевых путей

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6.
Рис. 6. Соотношение вариантов нарушений уродинамики диуретической пиелоэхографии при разных степенях гидронефроза

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7.
Рис. 7. Процентное соотношение пациентов с различной степенью тяжести нарушений уродинамики верхних мочевых путей (по сумме баллов) при разных вариантах диуретической пиелоэхографии

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