Outcome Analysis of Pediatric Pyeloplasty in Varied Presentation in Developing Countries

Abstract

Objectives: The objective was to study the various presentations of pelviureteric junction (PUJ) obstruction in developing countries and its outcomes. Materials and Methods: We retrospectively reviewed the medical records of 239 children (260 renal units) who underwent surgery for PUJ obstruction between January 1994 and December 2016. Data on the patients presenting with symptoms and preoperative imaging findings of ultrasonography, intravenous urography, or diuretic renography were analyzed. Results: In all cases, we preferred dismembered Anderson-Hynes pyeloplasty with or without JJ stenting. Complications of pyeloplasty included prolonged urine leakage in 13 patients, of whom 4 responded to conservative management, 5 required percutaneous nephrostomy (PCN), and 4 were treated with endoscopic JJ stenting. Six patients had persistent obstruction: two responded to endopyelotomy, and in four, redo pyeloplasty was successful. Five patients with renal function of <10% were initially treated with PCN and ultimately required nephrectomy. Conclusions: In patients born with PUJ obstruction and impaired renal function, pyeloplasty fails to significantly improve function, possibly because of cortical loss. However, in patients with antenatal PUJ obstruction managed expectantly, there is a small but significant risk of modest permanent loss of renal function.