臨床泌尿器科62巻10号

2008年09月発行

特集 EBMに基づく小児泌尿器科診療

EBMに基づく先天性腎盂尿管移行部通過障害（先天性水腎症）治療

著者： 島田憲次¹ 松本富美¹ 松井太¹ 小原崇¹

所属機関： ¹大阪府立母子保健総合医療センター泌尿器科

ページ範囲：P.757 - P.762

要旨　先天性水腎症は，出生前超音波診断の普及により無症候性に発見される機会が増えてきたが，その自然経過がいまだに不明なことや，胎児期から始まる尿路通過障害の病態が解明されておらず，治療目標となる分腎機能の悪化を早く捉え，不可逆的機能低下をきたす以前に手術に踏み切るため，さまざまな画像検査が工夫されて，その成績が集約されつつある。

参考文献

1）Carr MC and El-Ghoneimi A：Anomalies and surgery of the ureteropelvic junction in children. In：Campbell's Urology, 9th ed. edited by Wein JW, Kavoussi LR, Novick AC, et al. Saunders, Philadelphia, pp3359, 2007

2）Koff SA：Pathophysiology of ureteropelvic junction obstruction：clinical and experimental observation. Urol Clin North Am 2：2, 1990

3）Koff SA：Neonatal management of unilateral hydronephrosis. Urol Clin N Amer 25：181-186, 1998

4）小児泌尿器科学会学術委員会：周産期，乳児期に発見される腎盂，腎盂尿管拡張の診断基準：1．超音波断層法を用いた腎盂，腎盂尿管拡張の記載方法，2．利尿レノグラフィー実施のための標準プロトコール．日小泌尿会誌 8：96-99，1999

5）Ulman I, Jayanthi VR and Koff SA：The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol 164：1101-1105, 2000

6）Ransley PG, Dhillons HK, Gordon I, et al：The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144：584-587, 1990

7）Matsui F, Shimada K, Matsumoto F, et al：Late reccurence of symptomatic hydronephrosis in patients with prenatally detected hydronephrosis and spontaneous improvement. J Urol 180：322-325, 2008

8）Matsumoto F, Shimada K, Kawagoe M, et al：A delayed decrease in differential renal function after successful pyeloplasty in children with unilateral antenatally detected hydronephrosis. IJ Urol 14：488-490, 2007

9）Snyder HM Ⅲ, Lebowitz RL, Colodny AH, et al：Ureteropelvic junction obstruction in children. Urol Clin North Am 7：273, 1980

10）Lee JH, Choi HS, Kim JK, et al：Nonrefluxing neonatal hydronephrosis and the risk of urinary tract infection. J Urol 179：1524-1528, 2008

11）Thomas DFM：Fetal urology and prenatal diagnosis. In：Clinical Pediatric Urology, 4th ed. edited by Belman B, King LR and Kramer SA. Martin Dunitz, London, pp65-81, 2002

12）Lobowitz RL and Blickman JG：The coexistence of ureteropelvic junction obstruction and reflux. AJR Am J Roentgenol 140：231, 1983

13）Dhillon HK：Prenatally diagnosed hydronephrosis：selective postnatal intervention. Dial Pediatr Urol 25：5-7, 2002

14）Chu WCW, Lam WWM and Chan KW：Dynamic gadolinium-enhanced magnetic resonance urography for assessing drainage in dilated pelvicalyceal systems with moderate renal function：preliminary results and comparison with diuresis renography. BJU Int 93：830-834, 2004

15）Whitaker RH：Methods of assessing obstruction in dilated ureters. Br J Urol 45：15-21, 1973

16）Palmer LS, Maizels M, Cartwright PC, et al：Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis：a report from the Society for Fetal Urology. J Urol 159：222-228, 1998