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Long-Term Results of Anderson-Hynes Pyeloplasty in Children: How Long Follow-Up Is Necessary?
Leonardo Oliveira Reis1, Osamu Ikari1, Emerson Luís Zani1
1Department of Urology, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
Insights
Children with successful pyeloplasty may not require long-term follow-up if imaging is normal at 3-6 months. Significant changes in differential renal function (DRF) may indicate a need for intervention to preserve kidney function.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Uretero-pelvic junction obstruction (UPJO) is a common congenital anomaly.
- Pyeloplasty is the standard surgical treatment for UPJO.
- The necessity of prolonged post-operative follow-up after pyeloplasty remains a clinical question.
Purpose of the Study:
- To evaluate the need for long-term follow-up after successful pyeloplasty in children.
- To identify predictors of renal function stability or deterioration post-pyeloplasty.
Main Methods:
- Retrospective review of 28 pediatric patients who underwent dismembered pyeloplasty for UPJO.
- Analysis of ultrasonography, differential renal function (DRF) via DMSA, and diuretic renography (DTPA-Tc99) at 3 and 6 months, and annually thereafter.
- Exclusion criteria included bilateral UPJO, solitary kidney, VUR, other abnormalities, and poor initial renal function.
Main Results:
- All 28 renal units maintained renal function and patency during a median follow-up of 10.7 years.
- 75% of patients had a drainage half-time (T1/2) < 20 minutes at 3 months.
- One patient (3.6%) experienced renal function deterioration (>8% DRF fluctuation) requiring intervention.
Conclusions:
- A satisfactory diuretic renogram at 3-6 months post-pyeloplasty indicates no need for extended follow-up.
- A fluctuation in DRF exceeding 8% may be a critical threshold for intervention to preserve nephrons.
Purpose:
After a successful pyeloplasty at 3 to 6 months, the question remains whether children need a long follow-up.
Methods:
The medical charts of patients with long-term follow-up (> 5 years), who underwent dismembered pyeloplasty for uretero-pelvic junction obstruction (UPJO) from May 1998 to May 2007, excluding those with bilateral UPJO, solitary kidney, associated vesicoureteral reflux or other abnormalities, and inconclusive renogram due to poor renal function, were retrospectively reviewed. Ultrasonography, differential renal function (DRF, DMSA), and renal drainage on diuretic renography (diethylene-triamine-pentaacetate technetium-99 or DTPA-Tc99) were performed at 3 and 6 months every year.
Results:
Complete data were available for 28 consecutive patients (28 renal unities) with 2 months to 12 years (mean age, 2.4 years) at surgery, of whom 21 (75%) were boys, 17 diagnosed prenatally (61%) and 18 unities (64.3%) were left, with median follow-up of 10.7 years. Images were graded according to the Society for Fetal Urology grading system: Grade III in 11 (49%) and grade IV in 17 (61%). All cases presented > 10% DRF (DMSA) and obstructed DTPA-Tc99. The T1/2 (the half-time of drainage) less than 20 minutes at 3 months was found in 21 cases (75%) and less than 25 minutes in 7 cases (25%). Renal function and patency were maintained during follow-up for all units with 8% maximum fluctuation of DRF. One index case (3.6%) of renal function deterioration presented DRF fluctuation > 8% at 3 months (from 23 to 32%) and progressive hydronephrosis and indeterminate DTPA at 6 months.
Conclusions:
Satisfactory diuretic renogram at 3 to 6 months after pyeloplasty with maintained renal function and stable hydronephrosis suggests no need for further follow-up and indicates no functional loss with time. More than 8% DRF fluctuation might be a significant cutoff for further intervention aiming nephron preservation.
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