Morphological and functional outcome of dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction
Objective: To evaluate the morphological and functional outcome of dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction (UPJO).
Patients and methods: We retrospectively reviewed the medical records of all children subjected to dismembered pyeloplasty in the department of urology at Al-Azhar University hospitals between January 2004 and December 2011. The preoperative data included the personal history and imaging. Furthermore, the details of surgery and the postoperative course were evaluated. Only children with primary unilateral UPJO were included in this study. Preoperative radiological assessment included renal ultrasonography, magnetic resonance urography (MRU) and diuretic renography for all patients. All cases showed hydronephrosis with an obstructive renal pattern. Dismembered pyeloplasty (Andersen-Hynes) was performed via an open or laparoscopic approach. All cases were followed up clinically and radiologically at regular intervals for the assessment of both morphological and functional outcome. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit.
Results: During the study period, 83 children were subjected to dismembered pyeloplasty for the treatment of UPJO. Two thirds of the cases were boys. The median age was 4 years (range: 2 months to 17 years). Mean follow-up was 53 (range 14–96) months. The overall success rate was 94% with success being defined as stability or improvement of split renal function (SRF) with no further symptoms. Secondary procedures were needed in 5 patients (6%) showing deterioration of SRF. One patient underwent redo pyeloplasty, whereas endopyelotomy was done in 4 cases. In the remaining 77 patients (94%), radiological follow-up revealed stability or improvement of SRF with no further symptoms. Postoperative diuretic renography showed normal drainage in 52 (62.7%) and prolonged drainage in 31 cases (37.3%). Stability or improvement of hydronephrosis was seen in 75 (90.4%) cases.
Conclusion: Dismembered pyeloplasty is a safe and effective treatment of UPJO in children, not only relieving obstruction but also improving renal function.
KEYWORDS Children; Hydronephrosis; Ureteropelvic junction obstruction (UPJO); Pyeloplasty; Split renal function