Predictors of Recoverability of Renal Function after Pyeloplasty in Adults with Ureteropelvic Junction Obstruction

Abstract

Background: This study aimed to identify factors predicting the recoverability of renal function after pyeloplasty in adult patients with ureteropelvic junction obstruction. Methods: We retrospectively reviewed 138 adults with unilateral renal obstruction-induced hydronephrosis and who underwent Anderson-Hynes dismembered pyeloplasty from January 2013 to January 2016. Hydronephrosis was classified preoperatively according to the Society for Fetal Urology (SFU) grading system. All patients underwent Doppler ultrasonography, excretory urography, computed tomography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope (99mTc DTPA) renography before and after surgery. Renal resistive index (RRI) and 99mTc DTPA renography were repeated at 1, 3, 6, and 12 months. Results: Multivariate analysis identified age, renal pelvic type, SFU grade, preoperative RRI, decline of RRI, and renal parenchyma to hydronephrosis area ratio (PHAR) as independent predictors of renal function recoverability after pyeloplasty. However, preoperative RRI and RRI decline were not significantly associated with recoverability of renal function in patients aged >35 years. Lower preoperative RRI, greater decline in RRI, higher PHAR, lower SFU grade, and extrarenal pelvis were associated with greater improvements in postoperative renal function. Conclusions: Preoperative differential renal function cannot independently predict the recoverability of postoperative renal function in adult patients with unilateral renal obstruction-induced hydronephrosis. SFU grade, renal pelvic type, PHAR, preoperative RRI, and decline in RRI were significantly associated with the recoverability of renal function in adult patients aged <35 years, while only SFU grade, renal pelvic type, and PHAR were significantly associated with renal function recoverability in patients aged ≥35 years. Renal function recovery was better in patients younger than 35 years when compared with older patients.

A Simple Modification for the Usage of Flexible Cystoscope in Modified Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction with Renal Calculi: A Flexible Guiding Tube

“…And we think that metabolic factors should be taken into consideration when UPJO is complicated by calculi, and thus further studies are needed to analyze the ingredients of stones. Li et al [32] reported that renal function recovery was better in patients younger than 35 years. And we think that further studies about renal function recovery after surgery in UPJO with concomitant renal calculi are also needed.…”

Functional outcomes after pyeloplasty in solitary kidneys: structured analysis with the implication of Acute Kidney Injury Network (AKIN) staging criteria to predict long‐term renal function recoverability

“…[16], documented that patients with a preoperative SRF of ≤40% with more PT were most likely to show improvement in postoperative SRF at follow‐up. Recently, in another study including 138 adults who underwent pyeloplasty, 52% of them had improved renal function at the 1‐year follow‐up [6].…”

“…Li et al . [6] concluded that patient age, grade of hydronephrosis, and preoperative renal RI were independent factors for recoverability in adult patients. We excluded elderly patients (aged >50 years), as renal mass and function decline with the ageing process and the steepest decline is observed after the age of 50 years [21,22].…”

“…Numerous investigators have studied the impact of pyeloplasty on renal function recoverability. It was reported that renal function recoverability depends on the patient’s age, preoperative split renal function (SRF), preoperative selective GFR, renal perfusion, Resistive Index (RI), and degree of parenchymal thickness (PT) [4–7]. It is known that the confounding effects of the contralateral kidney may hamper the accurate assessment of pyeloplasty on renal function in the affected kidney.…”

The features of technetium-99m-DTPA renal dynamic imaging after severe unilateral ureteral obstruction in adult rabbits

“…Li XD et al [28] thought that it was not accurate to predict postoperative renal function recovery using preoperative renal function measurements. However, Kumar et al [29] believed that patients with fewer changes in obstructive renal function before surgery showed better recoverability after surgery.…”