The Trend of Indication of Nephrectomy in Infants and Children

Hwang, Keun; Choi, Seung Kang

Abstract

The nephrectomy has been one of the important urologic surgery as the final treatment of the various renal diseases. Recently the conservative plastic surgery is preferred with the development of the better assessment of the renal function and operating techniques but the numerous renal diseases like renal malignancies are still indications of the nephrectomy. This study was performed to observe the trend of diagnosis and treatment of the pediatric renal disease which could be treated by the nephrectomy previously, by comparing and classifying the frequency of the kidney of which the function was partially or completely recovered by the conservative plastic surgery. On the patients under the age of 15 who were admitted to the Yonsei University Medical Center from 1968 to 1987, the disease entities(ureteropelvic junction obstruction, renal anomaly, renal tuberculosis, renal injury, wilms` tumor) which could be considered the nephrectomy as a treatment method were studied with the division of 2 periods by 1981 on which the ultrasonography and 99 mTc-DTPA renography were performed. The results are as follows : 1.In the ureteropelvic junction obstruction the nephrectomy was decreased from 67.6% (23 in 34 kidneys) in the period I to 19.5%(8 in 41 kidneys) in the period II and in the grade IV and V hydronephrotic kidneys which showed the change in the treatment method during the 2 periods the pyeloplasty was increased from 23.3%(7 in 30 kidneys) in the period I to 74.2%(23 in 31 kidneys) in the period II. Of the 19 kidneys assessed by diuresis renography both before and after the pyeloplasty in the period II17 kidneys(89.4 %) showed improvement in the excretory function after surgery. 2.The nephrectomy is an indispensable treatment in the Wilms` tumor(54 kidneys) and was performed invariably in the renal tuberculosis(9 kidneys) which had multiple ureteral strictures or destructive changes in the whole kidney. The conservative plastic surgery was performed in the renal anomaly(28 kidneys) inappreciably and the renal injury(9 kidneys) became to be preferred the conservative treatment or partial nephrectomy if possible.