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Successful early pyeloplasty in infants
Bozidar Zupancic1, Anko Antabak, Ljiljana Popovic
1Department of Pediatric Surgery, University Hospital Renbro, Kispaticeva #12, Zagreb, 10000 Croatia. anko.antibak@zg.tel.hr
Insights
Early pyeloplasty for congenital ureteropelvic junction obstruction is safe and effective in infants. This study found good outcomes in both younger and older infants, supporting prompt surgical intervention to preserve kidney function.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Congenital ureteropelvic junction obstruction requires timely intervention to preserve renal function.
- Early pyeloplasty in infants is considered to maximize nephron salvage.
- Potential risks associated with operating on young infants must be carefully managed.
Purpose of the Study:
- To evaluate the outcomes of pyeloplasty in infants.
- To compare the results of pyeloplasty in younger infants (<2 months) versus older infants (>2 months).
- To determine if early surgical correction of ureteropelvic junction obstruction is justified in infants.
Main Methods:
- Retrospective analysis of infant pyeloplasty cases over a 5-year period.
- Open pyeloplasty was performed for deteriorated collecting systems, obstruction, or severe hydronephrosis.
- Comparison of surgical outcomes between infants <2 months and infants >2 months of age.
Main Results:
- 24 pyeloplasties in 22 younger infants and 30 in 27 older infants were performed.
- Younger infants more frequently presented in utero (75%), while older infants presented with UTIs (48%).
- Renal unit stability or improvement was observed in 23/24 younger and 24/30 older infant cases; 4 kidneys were not salvaged.
Conclusions:
- Pyeloplasty in infants yields good results, supporting early intervention.
- Prompt surgical correction of ureteropelvic junction obstruction in infants is recommended.
- Maximizing nephron salvage through early pyeloplasty is achievable with acceptable outcomes.
Background:
Early pyeloplasty for the treatment of congenital ureteropelvic junction obstruction to maximize nephron salvage is justified only if potential hazards of operating on small infants are avoided.
Methods:
The records were analyzed of all infants who underwent pyeloplasty over a 5-year period. Open pyeloplasty was performed if collecting systems had deteriorated or were demonstrated to be obstructed; it was also performed for severe cases of hydronephrosis. Outcome of surgery in the younger infant (patients <2 months of age) was compared with the older infant group (patients >2 months of age). Preoperative evaluation in case of mild or moderate hydronephrosis was directed toward ruling out a non-obstructed collection system and included voiding cystourethrography, and serial ultrasonography and/or dual isotope diuretic renography. Postoperative assessment consisted of serial ultrasonography and/or nuclear imaging to confirm decompression and relief of obstruction.
Results:
A total of 24 pyeloplasties were performed on 22 patients in the younger infant group (two bilateral) and 30 were performed on 27 infants in the older infant group (three bilateral). The only significant differences between the groups were as follows: patients in the younger infant group were likely to present in utero (75%, p = 2.69), whereas those in the older infant group were more likely to present with a urinary tract infection (48%, p = 4.12). During follow-up examination, 23 renal units in the younger infant group and 24 in the older infant group were judged to be stable or improved. Four kidneys were not salvaged after pyeloplasty, one in the younger infant group and three in the older infant group.
Conclusions:
Good results of pyeloplasties performed in the infants in this series support early correction of ureteropelvic junction obstruction in infants.