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Pyeloplasty vs. nephrectomy for ureteropelvic junction obstruction in poorly functioning kidneys (differential renal
M Gnech1, A Berrettini2, R I Lopes3
1Section for Paediatric Urology, Department of Surgical, Oncological, and Gastrintestinal Siences, University Hospital of Padova, Via Giustiniani, 2, 35127, Padua, Italy; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Paediatric Urology, Milan, Italy; Department of Surgery/Urology, McMaster University, Hamilton, Ontario, Canada.
Journal of Pediatric Urology
|July 7, 2019
Summary
Pyeloplasty for poorly functioning kidneys with ureteropelvic junction obstruction (UPJO) has similar complication rates to nephrectomy. While functional recovery is possible with pyeloplasty, it is not guaranteed, with postnatal diagnosis being a key predictor.
Area of Science:
- Urology
- Pediatric Surgery
- Nephrology
Background:
- Management of ureteropelvic junction obstruction (UPJO) in poorly functioning kidneys is debated.
- Surgical options include nephrectomy, pyeloplasty, or temporary diversion.
- This study compares complication rates and functional recovery between pyeloplasty and nephrectomy.
Purpose of the Study:
- To compare complication rates between pyeloplasty and nephrectomy for UPJO in kidneys with differential renal function (DRF) < 20%.
- To assess the potential for functional recovery after pyeloplasty in these cases.
Main Methods:
- Retrospective review of 77 patients with UPJO and DRF < 20% from 2000-2015.
- Comparison of short- and long-term complications between pyeloplasty (n=47) and nephrectomy (n=16) groups.
- Analysis of changes in DRF post-pyeloplasty.
Main Results:
- No significant difference in overall complications between pyeloplasty and nephrectomy.
- Nephrectomy more frequently used minimally invasive approach.
- Pyeloplasty failure rate was 3%; 36% of successful cases showed >5% DRF improvement, with postnatal diagnosis as a positive predictor.
Conclusions:
- Pyeloplasty is not associated with significantly higher morbidity than nephrectomy for UPJO in poorly functioning kidneys.
- Deferred nephrectomy is rarely needed after successful pyeloplasty.
- Approximately one-third of pyeloplasty cases without further surgery showed improved renal function.