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Outcome Analysis of Reduction and Nonreduction Dismembered Pyeloplasty in Ureteropelvic Junction Obstruction: A
Enono Yhoshu1, Prema Menon1, Katragadda Lakshmi Narasimha Rao1
1Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Renal pelvis reduction during pyeloplasty in children did not significantly alter renal function or drainage long-term. While reduction pyeloplasty showed faster initial drainage, long-term outcomes were similar between groups.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Renal Physiology
Background:
- Ureteropelvic junction obstruction is a common cause of pediatric kidney issues.
- Pyeloplasty is the standard surgical treatment.
- The role of renal pelvis reduction in pyeloplasty remains debated.
Purpose of the Study:
- To compare renal function and drainage after open dismembered pyeloplasty with and without renal pelvis reduction.
- To evaluate the impact of pelvis reduction on postoperative outcomes.
Main Methods:
- A randomized prospective study involving 42 children with ureteropelvic junction obstruction.
- Patients underwent pyeloplasty with (Group 1) or without (Group 2) renal pelvis reduction.
- Postoperative assessment included ethylene dicysteine (EC) scans, intravenous urography (IVU), and renal pelvis ultrasonography.
Main Results:
- No significant differences in renal function (EC scan) were observed between the groups at 3 months and ≥1 year post-surgery.
- While Group 1 showed slightly better early drainage, long-term drainage patterns were similar.
- Group 2 demonstrated a significant reduction in renal pelvis size on ultrasound at mean follow-up of 45.5 months.
Conclusions:
- Open dismembered pyeloplasty with or without renal pelvis reduction yields comparable long-term renal function and drainage.
- Reduction pyeloplasty may offer faster initial drainage, but this difference diminishes over time.
- Renal pelvis reduction is a safe adjunct that can lead to decreased pelvis size postoperatively.
Objectives:
The objective of this study is to compare the changes in renal function and drainage following open dismembered pyeloplasty with and without renal pelvis reduction.
Materials And Methods:
Randomized prospective study of children with ureteropelvic junction obstruction undergoing pyeloplasty with (Group 1) and without (Group 2) pelvis reduction over an 18-month period. Postoperative function and drainage were assessed by ethylene dicysteine (EC) scan and intravenous urography (IVU) and renal pelvis size by ultrasonography.
Results:
Forty-two patients (2 months-11 years) participated. The mean preoperative EC scan function was Group 1: 45.88% ± 14.42% (5%-80%) and Group 2: 39.22% ± 9.75% (21%-53%). (P = 0.117). The mean postoperative EC scan function of Group 1 was 42.64% ± 9.62% (17%-54%) and 43.75% ± 9.88% (17%-58%) and of Group 2 was 44.77% ± 12.82% (20%-68%) and 42.25% ± 8.56% (23%-58%) at 3 months (P = 0.584) and ≥ 1year (P = 0.385), respectively, with no significant difference. None required re-do pyeloplasty. The number of patients with slow drainage, especially at 3 months and also at ≥1-year postoperative period on EC scan was slightly higher in Group 2 compared to Group 1 but did not attain statistical significance. There was postoperative improvement in function and drainage on IVU with no significant difference between the two groups, (P = 0.214; P = 0.99, respectively). At a mean follow-up of 45.5 months, Group 2 also showed significant reduction in pelvis size on ultrasound (P = 0.011).
Conclusion:
Postoperative function remained stable in both groups. More number of patients achieved unobstructed drainage by 3 mo postoperative after reduction pyeloplasty but drainage patterns were mostly similar between reduction and nonreduction of pelvis group in late follow-up.
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