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Erschienen in:

14.12.2022 | Nierenbeckenabgangsenge | Leitthema

Chirurgische Intervention bei der kindlichen Ureterabgangsstenose

Wann sollte diese Maßnahme in Betracht gezogen werden?

verfasst von: PD Dr. med. Marcus Weitz

Erschienen in: Monatsschrift Kinderheilkunde | Ausgabe 1/2023

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Zusammenfassung

Hintergrund

Die Ureterabgangsstenose (UAST) kann zu einer Beeinträchtigung der Nierenfunktion führen. Daher ist das primäre therapeutische Ziel der Erhalt der Nierenfunktion.

Material und Methoden

Recherche in Literatur und Leitlinien.

Ergebnisse

Die aktuell zur Verfügung stehende Evidenz zur Therapie der UAST ist von unzureichender Qualität. Zudem ermöglicht die diagnostische Kombination aus Sonographie und funktioneller bildgebender Untersuchung, die für die Indikation einer chirurgischen Intervention entscheidend ist, keine zuverlässige Aussage über das Risiko einer Nierenfunktionsverschlechterung. Aus diesen beiden Gründen gibt es keine allgemein akzeptierten einheitlichen Leitlinien. Bei einer sonographisch darstellbaren höhergradigen Erweiterung des Nierenbeckenkelchsystems (meist III–IV°), einem anterior-posterioren Durchmesser des Nierenbeckens > 15 mm und weiteren vorliegenden sonographisch auffälligen Kriterien wird zumeist eine funktionelle bildgebende Untersuchung durchgeführt. Eine seitengetrennte Nierenfunktion < 35–40 % mit einem verzögerten Harnabfluss (nach Gabe von Furosemid), der als klinisch bedeutsam eingeschätzt wird, oder eine Verschlechterung der seitengetrennten Nierenfunktion um > 5–10 % im Verlauf wird zumeist als Indikation für eine chirurgische Intervention angesehen. Diese Empfehlungen können nur bei Patienten mit einseitiger UAST ohne assoziierte klinische Symptomatik und ohne weitere anatomische Auffälligkeiten der Nieren und ableitenden Harnwege angewendet werden. Eine Partialfunktion der Niere, die in der Erstuntersuchung deutlich erniedrigt ist, sollte nicht als alleiniges Kriterium für eine Nephrektomie betrachtet werden.

Schlussfolgerung

Trotz der unzureichenden Evidenz und der Limitationen der diagnostischen bildgebenden Untersuchung finden sich Übereinstimmungen in den verfügbaren Konsensusempfehlungen. Eine strukturierte sonographische Untersuchung und die Fortsetzung der begonnenen Standardisierung der bildgebenden Untersuchung zur besseren Vergleichbarkeit der klinischen Befunde sind dringend notwendig. Auch ist die Erforschung alternativer diagnostischer Ansätze für die verbesserte Indikationsstellung einer chirurgischen Intervention wünschenswert.

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Titel: Chirurgische Intervention bei der kindlichen Ureterabgangsstenose
Wann sollte diese Maßnahme in Betracht gezogen werden?
verfasst von: PD Dr. med. Marcus Weitz
Publikationsdatum: 14.12.2022
Verlag: Springer Medizin
Schlagwort: Nierenbeckenabgangsenge
Erschienen in: Monatsschrift Kinderheilkunde / Ausgabe 1/2023
Print ISSN: 0026-9298
Elektronische ISSN: 1433-0474
DOI: https://doi.org/10.1007/s00112-022-01664-9

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