The effect of ureteropelvic junction obstruction and pyeloplasty on somatic growth during infancy

Background: Evidence regarding the impact of perinatal ureteropelvic junction obstruction (UPJO) and surgical correction during infancy, on somatic growth are scarce. Understanding these impacts could help advise parents and aid in treatment decision making. Objectives: To assess the impact of unilateral UPJO and surgical correction on somatic growth in infants diagnosed antenatally and treated during infancy. Design: A retrospective bi-institutional analysis of somatic growth in patients under 2 years who underwent dismembered pyeloplasty for the treatment of UPJO was conducted. Methods: We evaluated patients who were diagnosed with unilateral hydronephrosis during pre-natal ultrasound screening for detection of fetal anomalies between May 2015 and October 2020. The height and weight of patients who were diagnosed with UPJO were recorded at the age of 1 month, time of surgery, and 6 months after surgery. Standard deviation scores (SDSs) for height and weight were calculated and compared. Results: Forty-eight patients under the age of 2 years were included in the analysis. Median age and weight at pyeloplasty were 6.9 months and 7.5 kg. At 1 month, the median SDS for weight in the entire cohort was –0.30 [interquartile range (IQR): –1.0 to 0.63] and the median SDS for height was –0.26 (IQR: –1.08 to 0.52). In 22.9% of patients (11/48), weight and height were below –1 age-appropriate standard deviations, and 6.3% (3/48) were below –2 standard deviations, suggesting growth restriction. When comparing SDS for the entire cohort, there was no significant difference corelated to measurement time or effect of surgery. In the growth restricted cohort, we found a significant improvement in linear growth for height, which was demonstrated between birth and surgery as well as after surgery. Conclusion: Infants with unilateral UPJO diagnosed antenatally as a single anomaly may be at an increased risk of somatic growth restriction in comparison with the general population. In children with growth restriction at time of birth, height seems to improve regardless of surgical treatment. Pyeloplasty during infancy does not seem to negatively affect somatic growth. These findings can be used to counsel parents regarding the potential effects of UPJO and pyeloplasty.

[1]  Anusiri Inugala.  Long term outcomes following pyeloplasty for unilateral pelviureteric junction obstruction in paediatric patients , 2021, International Surgery Journal.

[2]  L. Mohajerzadeh,et al.  Early pyeloplasty versus conservative management of severe ureteropelvic junction obstruction in asymptomatic infants. , 2020, Journal of pediatric surgery.

[3]  C. Peters,et al.  Managing Ureteropelvic Junction Obstruction in the Young Infant , 2020, Frontiers in Pediatrics.

[4]  R. Sixt,et al.  Changes in differential renal function after pyeloplasty in infants and children. , 2020, Journal of pediatric urology.

[5]  J. V. Van Batavia,et al.  Pediatric robotic-assisted laparoscopic pyeloplasty: Does age matter? , 2018, Journal of pediatric urology.

[6]  K. Skorecki,et al.  History of Childhood Kidney Disease and Risk of Adult End‐Stage Renal Disease , 2018, The New England journal of medicine.

[7]  V. R. Rathish,et al.  Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi-ureteric junction obstruction. , 2015, Journal of pediatric urology.

[8]  C. Cooper,et al.  Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). , 2014, Journal of pediatric urology.

[9]  P. Murray,et al.  Endocrine Control of Growth , 2013, American journal of medical genetics. Part C, Seminars in medical genetics.

[10]  S. Docimo,et al.  Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants. , 2013, The Journal of urology.

[11]  S. Warmann,et al.  Laparoscopic surgery on upper urinary tract in children younger than 1 year: technical aspects and functional outcome. , 2009, The Journal of urology.

[12]  P. Noh,et al.  Transperitoneal laparoscopic pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children: comparison with open surgery. , 2007, The Journal of urology.

[13]  E Borghi,et al.  Construction of the World Health Organization child growth standards: selection of methods for attained growth curves , 2006, Statistics in medicine.

[14]  M. Phillip,et al.  Endocrine Regulation of the Growth Plate , 2005, Hormone Research in Paediatrics.

[15]  J. Wit,et al.  Systemic and local regulation of the growth plate. , 2003, Endocrine reviews.

[16]  C. Bal,et al.  Urinary-tract infection affects somatic growth in unilateral symptomatic hydronephrosis , 2002, Pediatric Surgery International.

[17]  L. Mansi,et al.  Body growth in early diagnosed vesicoureteric reflux , 1999, Pediatric Nephrology.

[18]  C. Peters,et al.  Obstruction of the fetal urinary tract. , 1997, Journal of the American Society of Nephrology : JASN.

[19]  M. Papale,et al.  Catch-up growth in children with vesico-ureteric reflux , 1997, Pediatric Nephrology.

[20]  C. Polito,et al.  Height and weight in children with vesicoureteric reflux and renal scarring , 1996, Pediatric Nephrology.

[21]  R. Gonzalez,et al.  Pyeloplasty improves renal function and somatic growth in children with ureteropelvic junction obstruction. , 1995, The Journal of urology.

[22]  E. Hunziker.  Mechanism of longitudinal bone growth and its regulation by growth plate chondrocytes , 1994, Microscopy research and technique.

[23]  K. Schärer,et al.  Body growth in urinary tract malformations , 1993, Pediatric Nephrology.

[24]  R. Sutton,et al.  Physical growth velocity during conservative treatment and following subsequent surgical treatment for primary vesicoureteric reflux. , 1989, British journal of urology.

[25]  M. Koyle,et al.  Management of ureteropelvic junction obstruction in neonate. , 1988, Urology.

[26]  R. Merrell,et al.  Increased physical growth after successful antireflux operation. , 1979, The Journal of urology.

[27]  W. Uttley,et al.  Urinary Concentrating Ability and Growth Failure in Urinary Tract Disorders , 1972, Archives of disease in childhood.

[28]  W. C. Smith,et al.  An attempt to elucidate the cause of growth retardation in renal disease. , 1956, A.M.A. journal of diseases of children.

[29]  C. Wanner,et al.  Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract. , 2013, Clinical journal of the American Society of Nephrology : CJASN.