The risk factors and clinical significance of acute postoperative complications after unstented pediatric pyeloplasty: A single surgeon’s experience

Lee, Yong Seung; Lee, Cho Nyeong; Kim, Myung Up; Jang, Won Sik; Lee, Hyeyoung; Im, Young Jae; Han, Sang Won

doi:10.1016/j.jpedsurg.2013.11.003

Cited by 16 publications

(11 citation statements)

References 17 publications

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“…On the other hand, it was theorized that DRF >60% was the only independent risk factor associated with early postoperative complications (within the 1 st year postoperatively), including pyeloplasty failure (which was defined as worsening of the hydronephrosis and symptomatic obstruction). [ 25 ] In our study, no patients in the snDRF or nDRF groups developed clinical failure or obstructed T½ requiring reintervention at a long-term follow-up period reaching nearly 3 years’ period.…”

Section: Discussionmentioning

confidence: 59%

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

et al. 2020

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Introduction: Some patients with ureteropelvic junction obstruction (UPJO) have supranormal differential renal function (snDRF). We aimed to study the outcomes of pyeloplasty in adult patients with UPJO and either snDRF or normal differential renal function (nDRF) and to identify preoperative factors responsible for the snDRF phenomenon. Materials and Methods: We retrospectively retrieved data for all patients who underwent pyeloplasty and had snDRF (differential renal function [DRF] ≥55%) and nDRF (DRF between 45 and 55%) preoperatively. Preoperative radiological data using computed tomography or magnetic resonance imaging were correlated with the presence of snDRF phenomenon. In addition, scintigraphic findings pre- and post-operatively were also assessed to evaluate the functional outcomes. Results: Of a total of 856 patients, 31 had snDRF (group 1) and 42 had nDRF (group 2). After a mean of 37 months’ follow-up in Group 1, 22 patients developed DRF reduction with non-obstructive pattern. Mean DRF % decreased from 59 ± 2.8 to 48 ± 13 ( P < 0.0001). However, in Group 2, five patients had DRF decrease. Four patients developed snDRF phenomenon postoperatively. Increased renal pelvis volume ≥50 mm 3 and increased anteroposterior pelvic diameter (APD) ≥37 mm were found to predict snDRF phenomenon. The same findings, in addition to preoperative snDRF, correlated with postoperative DRF decrease. Conclusion: SnDRF function could be expected in patients with increased renal pelvis volume and APD. The absolute value or changes in DRF are not reliable to judge treatment failure.

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Section: Discussionmentioning

confidence: 59%

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

et al. 2020

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“…18,23 The success rate of open A-H dismembered pyeloplasty varies from 94 to 100% in different series. 2,3,12,15,18,21,23,30,31 Our success rate in both groups was nearly 100%. The outcome of repair regarding improvement of hydronephrosis and GFR was comparable in both groups (Table 3 and 4).…”

Section: Discussionmentioning

confidence: 67%

A comparative study of outcome of pyeloplasty in stented and non-stented children

2019

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Background: It is a matter of debate whether to use a stent (double J) or not during pyeloplasty in patients of pelvic ureteric junction obstruction (PUJ obstruction). This study was conducted to assess which technique- stented or non-stented is better for paediatric patients with PUJ obstruction.Methods: 45 paediatric patients aged 0-12 years were included in this prospective comparative simple randomized sample study during the period of June 2015 to August 2017 in paediatric surgery division of department of surgery in M.Y. Hospital, Indore. All patients except one underwent open A-H dismembered pyeloplasty. The parameters used for comparison were renal parenchymal diameter, renal pelvis AP diameter, GFR (by DTPA scan) and rate of complications. Minimum follow up period was 3 months.Results: The M:F ratio was 2:1. Stented children had significant improvement in renal parenchymal diameter (i.e. increase) and GFR (of affected kidney) after pyeloplasty, whereas non-stented children too had improvement in renal parenchymal diameter and GFR (affected kidney) but was not significant. The percentage of postoperative complications were more in non-stented group as compared to stented group.Conclusions: In all paediatric cases with PUJO undergoing A-H pyeloplasty, both stenting and non-stenting have similar results and to place a double J stent should depend on choice of surgeon.

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“…Thus, patients with PUJO and supranormal function should undergo close monitoring and early surgical repair if hydronephrosis or drainage time on renogram worsens. Likewise, supranormal function has already been identified as a risk factor for surgical treatment or acute postoperative complications .…”

Section: Discussionmentioning

confidence: 99%

Value of supranormal function on ^99mTc‐mercaptoacetyltriglycine renal scan in paediatric patients with obstructive hydronephrosis

et al. 2019

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Objectives To study related factors and clinical significance of supranormal function in paediatric patients with pelvi‐ureteric junction obstruction, and to predict which factors cause renal function overestimation. Patients and Methods Patients who underwent pyeloplasty from 2012 to 2017 were prospectively collected. Variables were compared between patients with and without supranormal function on 99mTc‐mercaptoacetyltriglycine renal scan (supranormal defined as differential renal function [DRF] ≥55%). Univariate, multivariate logistic and linear regressions analyses were performed. Results Of 100 patients, 18 were excluded because of comorbidities. Nine patients (11.5%) showed preoperative supranormal function. The preoperative anteroposterior pelvic diameter (APD; 24 mm vs 35 mm, P = 0.026) and the ratio between preoperative pelvic and kidney volumes (0.2 vs 0.6, P = 0.003) were higher in supranormal kidneys. For each unit increase in the preoperative ratio between pelvic and kidney volumes, the risk of supranormal function rose 3.23‐times (95% confidence interval [CI] 1.051–9.955). A preoperative APD ≥30 mm was a reliable predictor of supranormal function (area under the curve 0.804, 95% CI 0.707–0.902), with 88.9% sensitivity. Patients with either preoperative supranormal function or preoperative APD ≥30 mm had a greater reduction in renal function after pyeloplasty. Conclusion Supranormal function is related to large hydronephrosis where geometrical features are modified. A preoperative APD ≥30 mm is a reliable predictive factor of supranormal function. Preoperative renal function is overestimated either in supranormal patients or severe hydronephrotic kidneys. DRF should be interpreted with caution in kidneys with large hydronephrosis with or without supranormal function. Surgical indication should not entirely rely upon DRF.

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The risk factors and clinical significance of acute postoperative complications after unstented pediatric pyeloplasty: A single surgeon’s experience

Cited by 16 publications

References 17 publications

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

A comparative study of outcome of pyeloplasty in stented and non-stented children

Value of supranormal function on ^99mTc‐mercaptoacetyltriglycine renal scan in paediatric patients with obstructive hydronephrosis

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The risk factors and clinical significance of acute postoperative complications after unstented pediatric pyeloplasty: A single surgeon’s experience

Cited by 16 publications

References 17 publications

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

A comparative study of outcome of pyeloplasty in stented and non-stented children

Value of supranormal function on 99mTc‐mercaptoacetyltriglycine renal scan in paediatric patients with obstructive hydronephrosis

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Value of supranormal function on ^99mTc‐mercaptoacetyltriglycine renal scan in paediatric patients with obstructive hydronephrosis