DOI: http://dx.doi.org/10.18203/2349-2902.isj20213994

Long term outcomes following pyeloplasty for unilateral pelviureteric junction obstruction in paediatric patients

Anusiri Inugala

Abstract


Background: Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis. The gold standard treatment for PUJO is Anderson hynes (AH) dismembered pyeloplasty. The parameters to assess the post-operative outcomes of pyeloplasty include reduction in the AP diameter of the pelvis and increase in parenchymal thickness. The aim of the study was to find out the long-term outcomes following pyeloplasty for Ureteropelvic junction obstruction (UPJO) in paediatric patients.

Methods: A prospective study was done from September, 2014 to January, 2019. All children above the age of 2 months who presented with unilateral PUJO were included in the study. All patients underwent ultrasound of the kidneys and diuretic renogram. All patients underwent AH dismembered pyeloplasty. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit.

Results: 60 patients with unilateral intrinsic PUJO were included in this study. Post-operatively split renal function (SRF) improved in 42 patients, remained stable in 13, and deteriorated in 5 cases. Post-operative renal drainage improved in 40 patients, remained stable in 15 and deteriorated in 5.  The degree of hydronephrosis deteriorated in 5 cases but improved or was preserved in 55 cases. The renal parenchyma deteriorated in 7 cases. Overall success rate of AH dismembered pyeloplasty was 92%.

Conclusions: Dismembered pyeloplasty is a safe and effective treatment of PUJO in the pediatric population. Majority of the patients had an improved split renal function, renal drainage, cortical thickness, and decreased degree of hydronephrosis.


Keywords


Pelviureteric junction obstruction, Hydronephrosis, Anderson hyne’s dismembered pyeloplasty, Diuretic renogram

Full Text:

PDF

References


Capello SA, Kogan BA, Giorgi LJ, Kaufman RP. Prenatal ultrasound has led to earlier detection and repair of ureteropelvic junction obstruction. J Urol. 2005;174(4):1425-8.

Wiener JS, Emmert GK, Mesrobian HG, Whitehurst AW, Smith LR, King LR. Are modern imaging techniques over diagnosing ureteropelvic junction obstruction? J Urol. 1995;154(2):659-61.

Whitaker RH. Hydronephrosis. Ann R Coll Surg Engl. 1977;59(5):388-92.

Goguş C, Karamursel T, Tokatli Z, Yaman O, Ozdiler E, Gogus O. Long-term results of Anderson-Hynes pyeloplasty in 180 adults in the era of endourologic procedures. Urol Int. 2004;73(1):11-4.

Tapia J, Gonzalez R. Pyeloplasty improves renal function and somatic growth in children with ureteropelvic junction obstruction. J Urol. 1995;154(1):218-22.

Glick PL, Harrison MR, Noall RA, Villa RL. Correction of congenital hydronephrosis in utero III. Early mid-trimester ureteral obstruction produces renal dysplasia. J Pediatr Surg. 1983;18(6):681-7.

Gordon I. Diuretic renography in infants with prenatal unilateral hydronephrosis: an explanation for the controversy about poor drainage. BJU Int. 2001;87(6):551-5.

Reilly P, Aurell M, Britton K, Kletter K, Rosenthal L, Testa T. Consensus on diuresis renography for investigating the dilated upper urinary tract. Radionuclides in Nephrourology Group. Consensus Committee on Diuresis Renography. J Nucl Med. 1996;37(11):1872-6.

Palmer LS, Maizels M, Cartwright PC, Fernbach SK, Conway JJ. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol. 1998;159(1):222-8.

Sandro MJ, Kogan BA. Neonatal management. Role for early intervention. Urol Clin North Am. 1998;25(2):187-97.

Chertin B, Fridmans A, Knizhnik M, Hadas HI, Hain D, Farkas A. Does early detection of ureteropelvic junction obstruction improve surgical outcome in terms of renal function?. J Urol. 1999;162(3):1037-40.

Aleer IM, Kaplan GW. Renal function before and after pyeloplasty: does it improve? J Urol. 1999;162(3):1041-4.

Salem YH, Majd M, Rushton HG, Belman AB. Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J Urol. 1995;154(5):1889-93.

Amarante J, Anderson PJ, Gordon I. Impaired drainage on diuretic renography using half-time or pelvic excretion efficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. J Urol. 2003;169:1828-31.

Capolicchio G, Leonard MP, Wong C, Jednak R, Brzezinski A, Salle JL. Prenatal diagnosis of hydronephrosis: impact on renal function and its recovery after pyeloplasty. J Urol. 1999;162(3):1029-32.

Saunders CA, Choong KK, Larcos G, Farlow D, Gruenewald SM. Assessment of pediatric hydronephrosis using output efficiency. J Nucl Med. 1997;38(9):1483-6.

Rossleigh MA, Leighton DM, Farnsworth RH. Diuresis renography. The need for an additional view after gravity-assisted drainage. Clin Nucl Med. 1993;18(3):210-3.