Long‐term functional and morphological outcome after pyeloplasty for huge renal pelvis

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE • To evaluate the functional and morphological outcome after open pyeloplasty for ureteropelvic junction obstruction (UPJO) with huge renal pelvis. PATIENTS AND METHODS • A retrospective review of all cases who underwent pyeloplasty for huge renal pelvis was conducted. • Records were evaluated with respect to age at presentation, preoperative imaging, surgical details and postoperative course. Patients were followed up regularly for both functional and morphological outcome. • Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow‐up. RESULTS • Between 1998 and 2008, 526 cases of primary UPJO underwent open dismembered pyeloplasty at our centre. • Of these patients, 41 (8%) had UPJO with huge renal pelvis. • No perioperative complications were encountered in the study group. Mean (range) follow‐up was 34 (18–84) months and nine patients were lost to follow‐up. The overall success rate was 91%. • Two patients underwent redo pyeloplasty, whereas secondary nephrectomy was necessary in one. • Improvement of hydronephrosis was evident in all patients, except in three patients who underwent secondary procedures. • However, persistent obstruction on diuretic renography was seen in most cases (65%). CONCLUSIONS • Open pyeloplasty for huge pelvis UPJO is feasible with a high success rate. • Varying degrees of hydronephrosis and radiological obstruction after pyeloplasty are not uncommon. • Nephrectomy is rarely indicated in cases with severely deteriorated renal function.

Comparative Study of Dismembered and Non-Dismembered Pyeloplasty

“…All the patients under the age of 10 were males. This finding is consistent with other case series' 8,10,11 In this study about 90% of patients complained of pain at the time of presentation Nausea and/or vomiting was the prime complaint of many patients. Patients who underwent dismembered pyeloplasty had nausea and vomiting as their presenting complaint.…”

“…The aim of the study is to compare non-dismembered pyeloplasty with dismembered pyeloplasty. Our observations and results were discussed and compared with other studies on the similar lines 8,9,10,11 . In my study youngest patient was 1 month old while the oldest one was 45 years old.…”

Can Renal Ultrasonography Predict Early Success after Pyeloplasty in Children? A Prospective Study

“…An Anderson-Hynes dismembered pyeloplasty is the standard procedure performed, together with resection of the dilated renal pelvis [11]. The decision for surgical intervention is usually based on the decrease in DRF on diuretic renogram and the worsening of hydronephrosis on USG [5].…”

Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide

“…According to some reports, HN improves after pyeloplasty: HN disappears in 80-90% of patients, remains unchanged in 10-20% of patients and worsens in approximately 0-5% of patients. [74][75][76][77] Although there are neither standardized examinations nor specific follow-up intervals nor standard follow-up protocols, US is recommended as a standard examination for postoperative follow up. 78 DR is not essential, except in cases of suspected aggravation of HN.…”