Related Experiment Video
Updated: Jun 28, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Surgical management of failed pyeloplasty in children: single-center experience
Tamer E Helmy1, Osama M Sarhan, Ashraf T Hafez
1Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
Insights
Secondary surgery for failed pyeloplasty in children is highly successful, with most patients achieving symptom relief and obstruction resolution. Reoperation offers excellent functional outcomes, preserving kidney function.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Ureteral Reconstruction
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of congenital hydronephrosis in children.
- While primary pyeloplasty has a high success rate, a small percentage of patients experience recurrent obstruction.
- Failed pyeloplasty necessitates secondary surgical management to preserve renal function.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of secondary surgical procedures for managing failed pyeloplasty in pediatric patients.
- To assess the success rates and functional results of reoperative surgery for recurrent UPJ obstruction.
Main Methods:
- A retrospective review of 18 pediatric patients who underwent secondary surgery for failed pyeloplasty between 1996 and 2007.
- All secondary interventions were performed via open operative procedures.
- Clinical and radiological outcomes were assessed, with success defined by symptomatic relief and radiographic resolution of obstruction.
Main Results:
- The overall salvage rate for failed pyeloplasty was 89% (16 out of 18 patients).
- Secondary pyeloplasty was successful in 14 patients (78%), and ureterocalyceal anastomosis in 2 patients (11%).
- Two patients (11%) required nephrectomy due to severely deteriorated renal function; no perioperative complications were observed.
Conclusions:
- Persistent UPJ obstruction after primary pyeloplasty is an infrequent but manageable complication.
- Secondary surgical procedures for failed pyeloplasty demonstrate a very high success rate with excellent long-term functional results.
- Nephrectomy is reserved for rare cases with significantly compromised renal function.
Purpose:
To evaluate the outcome of secondary surgical procedures for the management of failed pyeloplasty in children.
Materials And Methods:
Between 1996 and 2007, 590 cases of primary ureteropelvic junction (UPJ) obstruction underwent open dismembered pyeloplasty at our center. Of these patients, 18 (3%) with recurrent UPJ obstruction (14 males, 4 females; age range: 2-15 years) have undergone management of failed pyeloplasty. Secondary intervention was by open operative procedure in all cases. Clinical and radiological outcomes were assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up.
Results:
Follow up ranged from 8 to 41 months (mean 28). The overall salvage rate was 89%. Secondary reoperative surgery was successful in 16 patients: dismembered pyeloplasty in 14 patients (78%) and ureterocalyceal anastomosis in 2 (11%). Nephrectomy was necessitated in 2 patients (11%). No perioperative complications were encountered. All patients showed stability of renal function on radiological follow up without evidence of obstruction and with no further symptoms.
Conclusion:
Persistent UPJ obstruction after pyeloplasty is an uncommon complication. Secondary procedures have a very high success rate with excellent functional results. Nephrectomy is indicated in rare cases of severely deteriorated renal function.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
01:25Urinary Tract Calculi VI: Surgical Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management