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Renal ultrasound changes after internal double-J stented pyeloplasty for ureteropelvic junction obstruction
S C Egan1, J A Stock, M K Hanna
1Section of Urology, Department of' Surgery, University of Medicine and Dentistry of New Jersey, USA.
Insights
Pediatric pyeloplasty with double-J stents shows rapid improvement in hydronephrosis, often resolving within 3 months. This stented approach leads to quicker recovery compared to unstented procedures for ureteropelvic junction obstruction.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of congenital hydronephrosis in children.
- Pyeloplasty is the gold standard surgical treatment for UPJ obstruction.
- The role of indwelling ureteral stents in pediatric pyeloplasty outcomes is debated.
Purpose of the Study:
- To evaluate the time to improvement or resolution of hydronephrosis after double-J stented pyeloplasty in pediatric patients.
- To compare the outcomes of stented pyeloplasty with previously reported results for unstented pyeloplasties.
Main Methods:
- Retrospective analysis of 26 pediatric patients undergoing double-J stented pyeloplasty for UPJ obstruction.
- Hydronephrosis grading using Society for Fetal Urology criteria at 0-3, 3-6, 6-12, and >12 months postoperatively.
- Comparison of ultrasound findings with historical data from unstented pyeloplasties.
Main Results:
- Significant improvement in hydronephrosis grade was observed within 3 months postoperatively in stented cases.
- 22% of grade 4 hydronephrosis cases resolved by 3 months after stent removal.
- Over 1-year follow-up, most patients showed improvement to grade 2 or less, with a more rapid trajectory than unstented procedures.
- Average indwelling time for double-J stents was 52 days.
Conclusions:
- Internal double-J ureteral stents facilitate rapid improvement and potential resolution of hydronephrosis after pyeloplasty for UPJ obstruction.
- The majority of renal units achieve grade 2 hydronephrosis or less within one year post-stented pyeloplasty.
- Routine use of double-J stents in pediatric pyeloplasty is recommended to expedite recovery and improve outcomes.
Purpose:
Renal ultrasound changes after pediatric pyeloplasty were reported recently in the literature, mainly on unstented pyeloplasties. We evaluated the time to improvement or resolution of hydronephrosis in pediatric patients who underwent double-J stented pyeloplasty for ureteropelvic junction (UPJ) obstruction and compared our results to unstented pyeloplasties.
Materials And Methods:
Ultrasonic grading of hydronephrosis after double-J stented pyeloplasty was performed according to the Society for Fetal Urology criteria at intervals of 0 to 3. 3 to 6, 6 to 12, and greater than 12 months postoperatively. Twenty-six pyeloplasties met all criteria for inclusion. The median patient age was 4 months.
Results:
Of the 26 pyeloplasties studied, 18 kidneys had grade 4, 7 grade 3, and I grade 2 hydronephrosis. Twenty-two percent of kidneys with grade 4 hydronephrosis had resolution of pyelocaliectasis at the 0- to 3-month ultrasound examination; all of these kidneys had the stents removed prior to being studied. No patient with improvement of hydronephrosis worsened on subsequent examinations. All but three patients improved over 1-year follow-up: 11 (42%) to grade 0, 5 (19.2%) to grade 1, 6 (23%) to grade 2, and 1 (3.8%) to grade 3. The average final grade was 1.56 for grade 4 and 0.57 for grade 3 hydronephrosis. This represented more rapid improvement than unstented pyeloplasties. Average indwelling time for double-J stent was 52 days.
Conclusions:
Improvement and sometimes resolution of hydronephrosis after internal double-J stented pyeloplasty for UPJ obstruction is rapid and can occur within the first 3 months postoperatively. One year postoperatively, the majority of renal units have grade 2 hydronephrosis or less. We recommend the use of indwelling double-J ureteral stents in all pediatric patients undergoing dismembered pyeloplasty for UPJ obstruction to allow for more rapid improvement and possible resolution ofpyelocaliectasis. Further comparison of stented vs. unstented pyeloplasty is needed.
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