Outcome and cost analysis of operative versus nonoperative management of neonatal multicystic dysplastic kidneys.
Annual Meeting of the Section on Urology, American Academy of Pediatrics. New Orleans, LA, USA, 1997/11/01.
We determine whether nephrectomy or observation is the more appropriate treatment of neonates with multicystic dysplastic kidney in terms of medical care and cost-effectiveness.
Materials and Methods
We retrospectively reviewed our 10-year clinical experience with 17 female and 32 male neonates presenting with multicystic dysplastic kidney who were followed with serial renal ultrasound.
The literature also was reviewed.
Nephrectomy was performed in 12 patients (24%) for various reasons, of which family request at concomitant surgery was the most common (7).
No kidney was removed due to hypertension or tumor.
In the remaining 37 patients followup continues (mean 42 months) with involution developing in 9 multicystic dysplastic kidneys (24%) and 9 patients (24%) lost to followup.
The total cost of 1-hour outpatient simple nephrectomy was estimated at $5,000 to $7,000 and, when performed as a concomitant procedure, it cost $2,000 to $5,000, the equivalent charges incurred for 17 to 28 serial ultrasound studies performed by a radiologist.
Our review of the literature revealed that children with multicystic dysplastic kidney are at minimal risk for hypertension, pain and infection.
The most important reason to perform screening renal ultrasound in this condition is to detect earlier stage Wilms tumor (3 to 10-fold the general pediatric population risk of 1/10,000 cases).
With a maximum risk of 0. (...)
Mots-clés Pascal : Rein polykystique, Dysplasie, Indication, Néphrectomie, Expectation, Effet biologique, Evolution, Coût, Analyse avantage coût, Nouveau né, Homme, Appareil urinaire pathologie, Rein pathologie, Maladie héréditaire, Tumeur bénigne, Kyste, Chirurgie, Economie santé
Mots-clés Pascal anglais : Polycystic kidney, Dysplasia, Indication, Nephrectomy, Expectation, Biological effect, Evolution, Costs, Cost benefit analysis, Newborn, Human, Urinary system disease, Kidney disease, Genetic disease, Benign neoplasm, Cyst, Surgery, Health economy
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0503976
Code Inist : 002B14C01. Création : 19/02/1999.