Demirtas Two-Step Treatment Model in Hypofunctional-Obstructed Kidneys: An Extended Series and Long-Term Prospective Results

Abstract

Aim: This study aimed to present the short- and long-term results of Demirtas two-step treatment model in patients with obstructed-hydronephrotic kidneys functioning below 10%, and before deciding on nephrectomy, to evaluate whether this method can contribute to the accurate assessment.

Material and methods: This prospective study included patients with unilateral renal obstruction and renal parenchymal loss assessed by computed tomography and whose renal function was found to be below 10% in Tc-99m-dimercaptosuccinic acid. In the first step, percutaneous nephrostomy (PCN) was performed. Two weeks later, the second step was performed, in which patients were offered nephrectomy (if renal function was <10%) or etiology-based treatment (if renal function was ≥10%).

Results: Thirty-eight patients were included in the study, comprising 20 (52.6%) men and 18 (47.4%) women with a mean age of 51.3±16.8 years. Mean baseline renal function was 6.0%, which increased to 10.8% two weeks after PCN (p=0.001). Renal function increased to above 10% in 20 (52.6%) out of 38 patients. Of these, 17 patients underwent etiology-based treatment and baseline, two-week, and 12-month renal function levels were 7.0%, 17.5%, and 18.8%, respectively (p<0.001).

Conclusion: Demirtas two-step treatment model introduced in the present study can be recommended as a standard treatment modality in unilaterally obstructed kidneys functioning below 10% ability.

Keywords: hydronephrosis; kidney; non-function; obstruction; percutaneous nephrostomy.