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Recurrent UPJ obstruction following paediatric pyeloplasty is associated with an initial <2.5cm incision open

Fadi Zu'bi1, Fardod O'Kelly2, Walid A Farhat3

  • 1Department of Urology, Rambam Health Care Campus, Haifa, Israel; Department of Urology, The Nazareth Hospital EMMS, Nazareth, Israel.

Urology
|August 24, 2022
PubMed

Insights

Open pyeloplasty increases complication risks in children, including recurrent obstruction and need for revision surgery. Laparoscopic pyeloplasty may offer better outcomes by reducing missed crossing vessel identification during initial repair.

Area of Science:

  • Pediatric Urology
  • Surgical Outcomes Research

Background:

  • Pyeloplasty is a common procedure for pediatric ureteropelvic junction obstruction.
  • The choice of surgical approach may influence patient outcomes and complication rates.

Purpose of the Study:

  • To identify risk factors impacting surgical outcomes in pediatric pyeloplasty.
  • To investigate if the operative approach (open vs. laparoscopic) affects these outcomes.

Main Methods:

  • Retrospective cohort study of 185 pediatric pyeloplasty cases (2008-2017).
  • Evaluation of clinicodemographic and operative characteristics.
  • Analysis of complications, re-stenosis, and revision rates using bivariate and multivariate logistic regression.

Main Results:

  • Open pyeloplasty was an independent predictor of overall complications, recurrent UPJ obstruction, and redo-pyeloplasty compared to laparoscopic approach.
  • Higher rates of missed crossing vessels were noted in redo-pyeloplasty cases initially treated with open surgery.
  • Complications occurred in 11.4% of patients, with 5.4% requiring revision pyeloplasty.

Conclusions:

  • Initial open pyeloplasty is associated with increased future complications, potentially due to missed crossing vessels.
  • Laparoscopic pyeloplasty may lead to better long-term outcomes.
  • Surgeons should consider the risk of missed vascular anomalies in open pyeloplasty procedures.
Abstract

Keywords:
Crossing vesselLaparoscopyPyeloplastyStenosisUreteropelvic obstruction

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