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Pyeloplasty may reverse the effect of growth delay from ureteropelvic junction obstruction in infants
Eric J Robinson1, Aaron Bayne2
1Department of Urology, Kaiser Permanente, Los Angeles, CA, USA. Eric.J.Robinson@kp.org.
Insights
Pyeloplasty significantly improved height and weight in infants with ureteropelvic junction obstruction (UPJO). This suggests UPJO can cause growth delays in children.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Growth and Development
Background:
- Congenital hydronephrosis due to ureteropelvic junction obstruction (UPJO) is common.
- The impact of UPJO on somatic growth is not well understood.
- Pyeloplasty is the standard surgical treatment for UPJO.
Purpose of the Study:
- To determine if pyeloplasty leads to clinically significant changes in somatic growth in children with UPJO.
- To compare growth outcomes between infants with UPJO treated with pyeloplasty versus observation.
Main Methods:
- Retrospective evaluation of growth data from infants with SFU grade 3 or 4 hydronephrosis.
- Comparison of height and weight percentiles pre- and post-intervention (6-16 months) in pyeloplasty (n=35) and observation (n=66) groups.
- Statistical analysis of interval changes in growth percentiles between groups.
Main Results:
- The pyeloplasty group had significantly lower pre-operative height percentiles (43rd vs. 55th) and were more likely to have delayed renal drainage.
- Following pyeloplasty, the surgery group showed significant increases in height (18.9 percentiles) and weight (6.0 percentiles).
- No significant differences in baseline gender, age, or weight percentiles were noted between groups.
Conclusions:
- Pyeloplasty in infants with UPJO is associated with significant improvements in height and weight at 6-16 months post-surgery.
- These findings suggest that UPJO may contribute to growth delay in infants.
- Observation alone did not yield similar growth improvements in the non-surgical group.
Purpose:
To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty.
Methods:
We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6-16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6-16 months later. Interval changes in group height and weight percentiles are compared for significant changes.
Results:
The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11-27) and weight (6.0 percentiles; 95% CI 0.50-12) after intervention.
Conclusions:
Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6-16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants.
