Pāpale ʻo UPJ

ʻO ka pale o Ureteropelvic (UPJ) kahi paʻa i ke kiko kahi e hoʻopili ai kahi ʻāpana o ka puʻupaʻa i kekahi o nā paipu i ka pūpū (ureter) Paʻa kēia i ke kahe o ka mimi mai ka puʻupaʻa.

Kū ka hakahaka ʻo UPJ i nā keiki. Hana pinepine ia i ka ulu ʻana o kahi pēpē i loko o ka ʻōpū. Kāhea ʻia kēia he kūlana hānau (mai ka wā hānau).

Hoʻokumu ʻia ka palaka ke loaʻa:

• ʻO kahi ākea o ka wahi ma waena o ka ureter a me ka ʻāpana o ke kīkī i kapa ʻia ʻo pelvis renal
• ʻO kahi kīʻaha koko e hele aʻe ma luna o ka ureter

A ʻo kahi hopena, kūkulu ka mimi a hōʻino hoʻi i ka hakuʻala.

I nā keiki makua a me nā mākua, pili ka pilikia ma muli o ka ʻaʻa maka, ka maʻi, nā lāʻau lapaʻau ma mua no ka ālai ʻana, a i ʻole nā ​​pōhaku hakuʻala.

ʻO ka pale ʻana ʻo UPJ ke kumu maʻamau o ka paʻa ʻana o ka urinary i nā keiki. ʻIke ʻia ia i kēia manawa ma mua o ka hānau ʻana me nā hōʻike ultrasound. I kekahi mau hihia, ʻaʻole e hōʻike ʻia ke ʻano a hiki i ka wā hānau. Pono paha ke ʻoki ʻana i ke kakahiaka nui inā pilikia ka pilikia. ʻO ka hapa nui o ka manawa, ʻaʻole pono ka ʻoki ʻana a ma hope. ʻAʻole koi kekahi mau hihia i ke kaha ʻana.

ʻAʻohe paha hōʻailona. Ke hiki mai nā ʻōuli, pili pū paha lākou:

• ʻO ke kua hoʻi a i ʻole flank ʻeha keu hoʻi e ʻai ana i nā diuretics e like me ka wai ʻona a me ka caffeine
• Mimi koko (hematuria)
• Lū i loko o ka ʻōpū (ʻōpū nui)
• Maʻi kīnā
• Ka ulu maikaʻi ʻole o nā pēpē (holo ʻole)
• ʻO ka maʻi urinary tract, maʻamau me ke kuni
• ʻO ka luaʻi

Hiki i kahi ultrasound i ka wā hāpai ke hōʻike i nā pilikia ʻōpū i loko o ka pēpē i hānau ʻole ʻia.

Hoʻokomo ʻia paha nā hoʻāʻo ma hope o ka hānau ʻana:

• BUNU
• ʻĀina Creatinine
• CT scan
• Nā uila
• IVP - hoʻohana liʻiliʻi ʻia
• CT urogram - scan i nā puʻupaʻa ʻelua a me nā ureter me ka ʻokoʻa IV
• Nuclear scan o nā puʻupaʻa
• Voiding cystourethrogram
• Kukuna ultrasound

ʻO ke kaha e hoʻoponopono ai i ka poloka e hiki ai i ka mimi e kahe maʻamau. ʻO ka hapanui o ka manawa, hana ʻia ke kaha hāmama (invasive) i nā pēpē. Hiki ke mālama ʻia nā mākua me nā kaʻina hana hoʻoemi liʻiliʻi. Pili kēia mau kaʻina hana i nā ʻoki ʻoki liʻiliʻi loa ma mua o ke kahakaha wehe, a hiki ke hoʻopili ʻia:

• ʻAʻole koi ka ʻenehana Endoscopic (retrograde) i kahi ʻokiʻoki ma ka ʻili. Ma kahi o, hoʻokomo ʻia i kahi mea kani i loko o ka uretra a me ka maʻi ʻaʻai a i loko o ka ureter i hoʻopili ʻia. ʻAe kēia i ke kaukipō e wehe i ka ālai mai loko.
• ʻO kaʻenehana Percutaneile (antegrade) kahi ʻoki liʻiliʻi ma ka ʻaoʻao o ke kino ma waena o nā iwi ʻaoʻao a me ka ʻūhā.
• Lawe ʻo Pyeloplasty i nāʻiʻo makaʻu mai kahi i ālai ʻia a hoʻohui hou i ka ʻāpana olakino o ka puʻupaʻa i ka ureter olakino.

Ua hoʻohana ʻia ʻo Laparoscopy e mālama i ka ālai ʻia o UPJ i nā keiki a me nā mākua i loaʻa ʻole ka kūleʻa me nā kaʻina hana ʻē aʻe.

Hiki ke kau ʻia kahi paipu i kapa ʻia i stent e hoʻokahe i ka mimi mai ka puʻukū a hiki i ka wā e ola ai ke ʻoki. ʻO kahi nephrostomy Tube, i waiho ʻia ma ka ʻaoʻao o ke kino e hoʻokahe i ka mimi, pono nō paha ia no kahi manawa pōkole ma hope o ke kaha ʻana. Hiki ke hoʻohana ʻia kēia ʻano o ka paipu e mālama i kahi maʻi maikaʻi ma mua o ke kaha ʻana.

ʻO ka ʻike ʻana a me ka mālama ʻana i ka pilikia ma mua e hiki ke pale i ka hōʻino ʻana o ka hakuʻala i ka wā e hiki mai ana. Hoʻomaopopo ʻia ʻo UPJ ālai ʻia ma mua o ka hānau a i ʻole ma mua o ka hānau ʻana e hoʻomaikaʻi paha iā ia iho.

Hana maikaʻi ka hapa nui o nā keiki a ʻaʻohe pilikia lōʻihi. Hiki ke hōʻino nui ʻia i ka poʻe i ʻike ʻia ma hope o ke ola.

Maikaʻi nā hopena wā lōʻihi me nā mālama o kēia wā. ʻO ka Pyeloplasty kahi kūleʻa lōʻihi lōʻihi loa.

Inā mālama ʻole ʻia, hiki i ka ālai ʻana iā UPJ ke alakaʻi i ka lilo mau loa o ka hana hakuʻala (kōpaʻa ʻole).

Hiki i nā pōhaku hakuʻala a i ʻole ka maʻi ʻino i loko o ka hakuʻala i hoʻopili ʻia, ʻoiai ma hope o ka mālama

Kāhea i ke kahu mālama ola inā loaʻa i kāu pēpē:

• Mimi koko
• Fiva
• He puʻupuʻu i loko o ka ʻōpū
• Nā hōʻailona o ka ʻehaʻeha a i ʻole ka ʻeha ma nā ʻaoʻao (ka wahi i nā ʻaoʻao o ke kino ma waena o nā iwi ʻaoʻao a me nā pelvis)

Pākuʻi Ureteropelvic; ʻO ke keʻakeʻa ʻo UP up; ʻO ka ālai ʻana o ka huina ureteropelvic

• Anatomia hakuʻala

ʻO Elder JS. ʻO ka ālai ʻana o ka maʻi urinary. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 555.

Frøkiaer J. Urinary tract keakea. I: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. ʻO Brenner a me Rector's The Kidney. 10 o ka lā. Piladelapia, PA: Elsevier; 2016: chap 38.

Meldrum KK. Pathophysiology o ka urinary tract ālai. I: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th hua. Piladelapia, PA: Elsevier; 2016: chap 48.

Nakada SY, ʻoi loa SL. Ka hoʻokele o ka luna urinary tract ālai. I: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th hua. Piladelapia, PA: Elsevier; 2016: chap 49.

ʻO Stephany HA, ʻOst MC. Nā maʻi Urologic. I: Zitelli BJ, McIntire SC, Nowalk AJ, eds. ʻO Zitelli lāua ʻo Davis 'Atlas o ka Pediatric Physical Diagnosis. ʻEpekema 7 Piladelapia, PA: Elsevier; 2018: chap 15.