Retrospective record review of postoperative obstruction for hydronephrosis in children

Abstract

Objective To explore the causes, treatments and prognosis of postoperative ureteropelvic junction obstruction(UPJO) for hydronephrosis in children. Methods Retrospective record reviews were conducted for 22 children undergoing reoperations for hydronephrosis from February 2009 to February 2015.The procedures included open redo pyeloplasty(n=20), renal pelvis incision fistula operation(n=1) and percutaneous nephrostomy(n=1). The causes of obstruction after initial operations included PUJ stenosis(16/20, 80%), high ureteral opening(7/20, 35%) and concurrent distal ureteral stricture(2/20, 10%). And 11 children were discharged from hospital after a removal of nephrostomy tube and nephrostomy tube was retained in another 7.Nephrostomy tube was removed in 6 outpatients and retained for 1 child operated in February 2015.Reoperation was performed for 2 children with distal ureteral stricture and then nephrostomy tube removed. Results The follow-up period was 3 months to 6 years.IVP, ultrasound and renal nuclide scan confirmed a patency of PUJ and a remission of hydronephrosis in 15 cases.Two non-imaging cases remained asymptomatic and 3 cases were not up to review time.No discomfort was found through a telephone follow-up.Another 2 cases received regular reexaminations without reoperation. Conclusions PUJ stenosis or high ureteral opening is a major cause of obstruction after pyeloplasty.And tension-free and low anastomosis is essential for avoiding postoperative obstruction.Redo pyeloplasty or ureterocalicostomy is employed for reoperation. Key words: Hydronephrosis; Obstruction at ureteropelvic junction; Pyeloplasty