Failed Pyeloplasty in Children: Revisiting the Unknown

Romao, Rodrigo; Koyle, Martin A.; Salle, João L. Pippi; Alotay, Abdulhakim; Figueroa, Víctor; Lorenzo, Armando J.; Bägli, Darius; Farhat, Walid A.

doi:10.1016/j.urology.2013.06.049

Cited by 47 publications

(36 citation statements)

References 5 publications

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“…14 However, these results are not always similar to those obtained with LP by experts. 4,5,13 In our experience similar results can be obtained, and although both techniques have a long learning curve, PE takes less operative time.…”

Section: Discussionsupporting

confidence: 77%

Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in Children

et al. 2015

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Section: Discussionsupporting

confidence: 77%

Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in Children

et al. 2015

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“…29 Lack of retrograde pyelogram during the initial procedure was raised as a possibility but it does not appear to be associated with failure rates. 30 Earlier theories that younger age (less than 6 months) at initial operation places patients at higher risk 29 are unsupported by more recent series 4,25 and by our study.…”

Section: Discussionmentioning

confidence: 46%

“…10,11 In fact worsening asymptomatic hydronephrosis accounts for a considerable proportion of pyeloplasty failures requiring surgical intervention at a rate higher than 40% in some series. 4,12 Late failures can present 8 or more years after primary pyeloplasty. 10,12 …”

Section: Discussionmentioning

confidence: 99%

“…In patients who underwent only 2 stent/drain placements the mean procedure-free interval of 21.7 months following the last stent/drain suggests greater long-term success than previously described for stenting alone. 4 Redo pyeloplasty was the next most common secondary procedure. MIP has grown increasingly common in the last 2 decades, accounting for 83% of adult cases in 2011.…”

Section: Discussionmentioning

confidence: 99%

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National Trends in Secondary Procedures Following Pediatric Pyeloplasty

Hsi

Holt

et al. 2016

Journal of Urology

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Purpose Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database. Materials and Methods Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics. Results We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively). Conclusions Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.

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“…It is currently beyond no doubt that open redo pyeloplasty for secondary UPJO is associated with excellent results and success rates of 100% and has been suggested as the first method of choice by different authors [3,5,20]. Laparoscopic salvage pyeloplasty for failed open procedures has become more popular and has been shown to associate excellent outcomes while providing the advantages of minimally invasive surgery.…”

Section: Discussionmentioning

confidence: 99%