Long term outcomes following pyeloplasty for unilateral pelviureteric junction obstruction in paediatric patients

Abstract

Background: Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis. The gold standard treatment for PUJO is Anderson hynes (AH) dismembered pyeloplasty. The parameters to assess the post-operative outcomes of pyeloplasty include reduction in the AP diameter of the pelvis and increase in parenchymal thickness. The aim of the study was to find out the long-term outcomes following pyeloplasty for Ureteropelvic junction obstruction (UPJO) in paediatric patients.Methods: A prospective study was done from September, 2014 to January, 2019. All children above the age of 2 months who presented with unilateral PUJO were included in the study. All patients underwent ultrasound of the kidneys and diuretic renogram. All patients underwent AH dismembered pyeloplasty. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit.Results: 60 patients with unilateral intrinsic PUJO were included in this study. Post-operatively split renal function (SRF) improved in 42 patients, remained stable in 13, and deteriorated in 5 cases. Post-operative renal drainage improved in 40 patients, remained stable in 15 and deteriorated in 5. The degree of hydronephrosis deteriorated in 5 cases but improved or was preserved in 55 cases. The renal parenchyma deteriorated in 7 cases. Overall success rate of AH dismembered pyeloplasty was 92%.Conclusions: Dismembered pyeloplasty is a safe and effective treatment of PUJO in the pediatric population. Majority of the patients had an improved split renal function, renal drainage, cortical thickness, and decreased degree of hydronephrosis.

The effect of ureteropelvic junction obstruction and pyeloplasty on somatic growth during infancy

“…As a substantial proportion of patients will experience improvement or resolution of hydronephrosis, corrective surgery, that is, pyeloplasty, is reserved for patients with worsening of hydronephrosis [Society for Fetal Urology (SFU) classification grade 3 or 4], deterioration of renal function, or complications. 4 The role of pyeloplasty in preventing renal function deterioration has been shown 5 , 6 and is considered the gold standard for treatment. However, the timing of surgery and surgical approach have been a matter of debate.…”