Predictors of Recurrence and Complications in Pediatric Pyeloplasty

Abstract

ObjectiveTo assess the predictors of recurrence and complications, we retrospectively analyzed our experience in primary pediatric pyeloplasty. Management of pyeloplasty failure is challenging both for patients and for surgeons, especially in pediatric cases. Early detection of recurrence and early manipulation may help preserving renal function. MethodsWe analyzed 490 renal units who underwent primary dismembered pyeloplasty with eligible data between June 2001 and October 2016 retrospectively. Patient's demographic features, operative data, clinical findings, complications, and recurrence rates were evaluated. ResultsMean age at operation and the mean follow-up time after pyeloplasty was 33.9 (±43.5) and 47.6 (±37.7) months. Our recurrence and complication rates were 6.7% and 11.4%, respectively. Urinary tract infection (7.8%), diversion-related complications (1.8%), and urinoma (1.4%) were the most common complications. Presence of preoperative diversion (P = .020) and presence of early complications (P < .001) after pyeloplasty were significantly related to recurrence. Complication rates were found less in children with transanastomotic diversions (P = .002) and children without preoperative diversion (P = .005). The analysis of patients in chronological order revealed an increase in prenatal diagnosis in the recent years (P < .001). Recurrence and complications were not related to age, gender, side, preoperative radionuclide renal scan results, hydronephrosis grade, surgery type, and surgical findings. ConclusionEarly postoperative complication is a predictor of recurrence after pediatric pyeloplasty. Transanastomotic diversion reduces the complication rates. Presence of a preoperative diversion increases both complication rates and recurrence rates after pyeloplasty.