Annals of Case Reports and Clinical Studies (ISSN: 2834-5673) | Volume 3, Issue 4 | Case Report | Open Access DOI
Batsukh Demberelnyambuu*
Batsukh Demberelnyambuu1*, Оlzvoi Аmarjargal1, Urtnasan Khurelbaatar1, Avirmed Shiirevnyamba2, Shonkhuuz Enkhtur1 and Sandag Baatartsogt1
1National Center for Maternal and Child Health, Mongolia
2Mongolian National University of Medical Science, Mongolia
*Correspondence to: Batsukh Demberelnyambuu
Fulltext PDFBackground: Hydronephrosis is recognized as the most frequent congenital urogenital anomaly in the pediatric population. The predominant cause is renal UPJ (ureteropelvic junction) obstruction, affecting roughly one in every 2,000 newborns. This condition arises from a blockage that hampers urine flow within the urinary tract, typically detected as hydronephrosis via imaging techniques. Children's urinary tract obstruction can vary in presentation, being either acute or chronic, partial or complete, and can affect one or both sides. In Mongolia, the criteria for Chronic Kidney Disease (CKD) surgery are determined by a combination of diagnostic measures: ultrasound, excretory urogram, and renal function as assessed by isotope analysis. Specifically, surgical intervention is considered when ultrasound reveals grade III-V hydronephrosis, the excretory urogram is at grade III-IV, and isotope analysis shows less than 30% excretory function. While laparoscopic surgery is gradually being integrated into pediatric renal surgical practice, open surgery remains selectively preferred, due to financial constraints and a lack of comprehensive research to support the widespread use of laparoscopic methods in pediatric renal surgery
Objectives: To evaluate and compare clinical symptoms, diagnostic accuracy, and the outcomes of laparoscopic versus open pyeloplasty surgeries.
Methods: The study included a case group of 15 children who underwent laparoscopic surgery at the National Medical Center's kidney surgery department between February 2020 and 8 months into 2023. These children were diagnosed with renal calcification and met the study's inclusion criteria.
Results: The clinical presentation of hydronephrosis included abdominal pain (n=15, 50.0%), tenderness (n=7, 23.3%), and fever (n=8, 26.7%). Blood tests revealed inflammatory changes in 40.0% (n=12) of cases. Urine analysis showed E.Coli and Enterobacter in 6.7% (n=2) of the cases. Blood biochemistry analysis indicated a significant decrease in creatinine levels post-surgery, from 87.3±14.0 mmol/L to 62.7±8.3 mmol/L (p=0.0001). Severity assessment of renal hydronephrosis revealed 43.3% (n=13) moderate cases and 56.7% (n=17) severe cases using conventional methods. A new method showed 26.7% (n=8) moderate and 73.3 (n=22) severe cases. The concordance between methods was 64.5% statically significant (p=0.014).
Conclusions: The concordance rate between conventional and new severity assessment methods and the absence of significant differences in surgical outcomes highlight the potential for standardized assessment and treatment strategies. The comparable efficacy of laparoscopic and open surgeries suggests a tailored approach to surgery, considering patient-specific factors and surgeon expertise.
Laparoscopic; Congenital; Hydronephrosis; Pediatric; Invasive
Batsukh Demberelnyambuu, Оlzvoi Аmarjargal, Urtnasan Khurelbaatar, Avirmed Shiirevnyamba, Shonkhuuz Enkhtur. Comparative Outcomes of Laparoscopic Versus Open Surgical Management for Pediatric Congenital Hydronephrosis. Ann Case Rep Clin Stud. 2024;3(4):1-11.