Morphological and functional outcome of dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction

E.M Salih

doi:10.1016/j.afju.2015.04.003

Abstract

ObjectiveTo evaluate the morphological and functional outcome of dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction (UPJO). Patients and methodsWe retrospectively reviewed the medical records of all children subjected to dismembered pyeloplasty in the department of urology at Al-Azhar University hospitals between January 2004 and December 2011. The preoperative data included the personal history and imaging. Furthermore, the details of surgery and the postoperative course were evaluated. Only children with primary unilateral UPJO were included in this study. Preoperative radiological assessment included renal ultrasonography, magnetic resonance urography (MRU) and diuretic renography for all patients. All cases showed hydronephrosis with an obstructive renal pattern. Dismembered pyeloplasty (Andersen-Hynes) was performed via an open or laparoscopic approach. All cases were followed up clinically and radiologically at regular intervals for the assessment of both morphological and functional outcome. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit. ResultsDuring the study period, 83 children were subjected to dismembered pyeloplasty for the treatment of UPJO. Two thirds of the cases were boys. The median age was 4 years (range: 2 months to 17 years). Mean follow-up was 53 (range 14–96) months. The overall success rate was 94% with success being defined as stability or improvement of split renal function (SRF) with no further symptoms. Secondary procedures were needed in 5 patients (6%) showing deterioration of SRF. One patient underwent redo pyeloplasty, whereas endopyelotomy was done in 4 cases. In the remaining 77 patients (94%), radiological follow-up revealed stability or improvement of SRF with no further symptoms. Postoperative diuretic renography showed normal drainage in 52 (62.7%) and prolonged drainage in 31 cases (37.3%). Stability or improvement of hydronephrosis was seen in 75 (90.4%) cases. ConclusionDismembered pyeloplasty is a safe and effective treatment of UPJO in children, not only relieving obstruction but also improving renal function.

Highlights

Ureteropelvic junction obstruction (UPJO) is one of the most common pathologies in pediatric urology
Diuretic renography providing information on split renal function (SRF) and renal drainage is of great importance for the diagnosis and follow-up of UPJO [3]
We evaluated the morphological and functional outcomes of dismembered pyeloplasty for the management of unilateral UPJO in children over a period of 8 years

Summary

Introduction

Ureteropelvic junction obstruction (UPJO) is one of the most common pathologies in pediatric urology. It is the most common cause of hydronephrosis in children. Anderson-Hynes dismembered pyeloplasty is the standard procedure performed for management of UPJO, either via an open or laparoscopic approach [1]. The advance of antenatal ultrasonography has resulted in earlier and more frequent diagnosis of hydronephrosis [2]. Diuretic renography providing information on split renal function (SRF) and renal drainage is of great importance for the diagnosis and follow-up of UPJO [3]. We evaluated the morphological and functional outcomes of dismembered pyeloplasty for the management of unilateral UPJO in children over a period of 8 years

Patients and methods

Results

Discussion