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Does Preoperative Function Affect the Outcome Following Pyeloplasty in Poorly Functioning Kidneys among Pediatric
Sharanbasappa Rudrawadi1, Gaurav Kochhar1, P Ashwin Shekhar1
1Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Anantapur, Andhra Pradesh, India.
Journal of Indian Association of Pediatric Surgeons
|November 3, 2021
Summary
Pyeloplasty is effective for poorly functioning pediatric kidneys, offering good intermediate-term results. This procedure should be considered upfront instead of nephrectomy, regardless of initial kidney function.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Poorly functioning kidneys in children often present challenges for treatment decisions.
- Nephrectomy is a common consideration, but less invasive options are being explored.
Purpose of the Study:
- To evaluate the efficacy and outcomes of pyeloplasty in pediatric patients with poorly functioning kidneys.
- To determine if pyeloplasty can be a primary treatment option, avoiding nephrectomy.
Main Methods:
- Retrospective analysis of 83 pediatric patients undergoing pyeloplasty for poorly functioning kidneys (2010-2015).
- Success defined by symptom improvement, stable/improved renal function, and drainage on Tc-99m DTPA scans.
- Patients stratified by preoperative differential renal function (DRF): Group I (<10%) and Group II (10%-30%).
Main Results:
- 80 patients completed the study; mean age 6.8 years.
- Significant improvement in mean DRF observed in both groups post-pyeloplasty (Group I: 7.58% to 29.71%; Group II: 20.81% to 37.25%).
- Overall success rate of 98% at 24-month follow-up.
Conclusions:
- Pyeloplasty demonstrates good intermediate-term efficacy even in severely compromised pediatric kidneys.
- Upfront pyeloplasty is a viable alternative to nephrectomy for pediatric patients, irrespective of preoperative renal function.
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