PD40-03 OUTCOMES OF PYELOPLASTY IN VERY POORLY FUNCTIONING KIDNEYS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion III1 Apr 2016PD40-03 OUTCOMES OF PYELOPLASTY IN VERY POORLY FUNCTIONING KIDNEYS rishi nayyar, siddarth yadav, and premnath dogra rishi nayyarrishi nayyar More articles by this author , siddarth yadavsiddarth yadav More articles by this author , and premnath dograpremnath dogra More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1535AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteropelvic junction obstruction (UPJO) may present in adulthood with significantly compromised ipsilateral renal function. Its management if the renal function is =20% or eGFR is =20ml/min is controversial. The literature remains silent on the morphological or functional results of pyeloplasty in this group and nephrectomy is also a feasible option. METHODS We retrospectively analysed patients who underwent pyeloplasty for primary UPJO in kidneys with very poorly functioning kidneys (split renal function of =20% or eGFR = 20ml/min). Perioperative complications and postoperative outcomes in terms of symptomatic improvement and functional stabilisation or recovery were assessed. RESULTS Total of 32 patients with eGFR =20ml/min or split function =20% underwent pyeloplasty since Jan 2010. 25 (78.1%) were males, mean age was 26.8 years (10-52 years) and 24 (75.0%) had left sided UPJO. Mean pre-operative split renal function was 20.3% (10-30%) and mean pre-operative eGFR was 17.0ml/min (9.3-26.0ml/min). Preoperative urinary diversion was performed in 5 patients (percutaneous nephrostomy (PCN) in 4 and double J (DJ) stent in 1). All patients underwent pyeloplasty (open -6, laparoscopic – 6, robotic – 20) with antegrade DJ stenting. 5 patients (15.6%) had complications in perioperative period (fever -2, raised TLC – 1, hematuria -1, failed antegrade DJ stenting - 1) which were mostly Clavien grade II and managed conservatively. All patients were followed for a mean period of 26.8 months and none required reintervention for obstructive drainage, deteriorating function or intractable pain. The mean post-operative split function was 19.4% (11-26%) and eGFR was 19.3 ml/min (11-31.2 ml/min). One patient had persistent pain requiring analgesics and overall success rate (defined as non-obstructive pattern, no deterioration in split function and no persistent symptoms) was 93.7%. 13 patients (40.6%) showed significant improvement in renal function (>5% over preoperative) and in all except 1 (3.1%) case there was no further deterioration of function. CONCLUSIONS Pyeloplasty provides high rates of morphological and functional success even in very poorly functioning renal units. There is a possibility of functional recovery in one third of patients and in most of the rest, there is no further deterioration. Nephrectomy may be avoidable in selected cases of very poorly functioning kidney with UPJO. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e936 Advertisement Copyright & Permissions© 2016MetricsAuthor Information rishi nayyar More articles by this author siddarth yadav More articles by this author premnath dogra More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...