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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Our experience on management of failed pediatric pyeloplasty
Erman Ceyhan1,2, Hasan Serkan Dogan3, Serdar Tekgul3
1Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey. erman_ceyhan@yahoo.com.
Insights
Redo pyeloplasty is the most effective treatment for recurrent ureteropelvic junction obstruction in children. Less invasive options like endopyelotomy and balloon dilation may be suitable for select cases.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Ureteral Obstruction
Background:
- Recurrent ureteropelvic junction obstruction after pyeloplasty presents a significant challenge in pediatric care.
- Salvage procedures for failed pyeloplasty are complex, especially in young patients.
Purpose of the Study:
- To evaluate the effectiveness of various salvage procedures following failed pediatric pyeloplasty.
- To identify the optimal surgical intervention for recurrent ureteropelvic junction obstruction in children.
Main Methods:
- Retrospective analysis of 40 children (41 renal units) treated for recurrent ureteropelvic junction obstruction post-pyeloplasty.
- Outcomes assessed for initial and subsequent interventions, including redo pyeloplasty, endopyelotomy, and balloon dilation.
Main Results:
- The overall success rates for redo pyeloplasty, double-J stent placement, endopyelotomy, and balloon dilatation were 78.9%, 46.1%, 38.8%, and 29.4%, respectively (p < 0.05).
- Redo pyeloplasty demonstrated the highest success rate (83.3%) compared to other initial interventions, though statistical significance was not reached in initial operations.
- Mean age at initial intervention was 45.9 months, with a mean follow-up of 46.9 months.
Conclusions:
- Redo pyeloplasty is the preferred method for improving recurrent ureteropelvic junction obstruction in pediatric patients.
- Endopyelotomy and balloon dilatation represent viable, minimally invasive alternatives for select pediatric cases.
Purpose:
The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention.
Methods:
40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation.
Results:
Children's mean age at initial intervention for failed pyeloplasty was 45.9 (± 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (± 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05).
Conclusions:
Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.
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