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Can We Predict Renal Function Recovery After Pyeloplasty in Pediatrics with Ureteropelvic Junction Obstruction? A
Safendra Siregar1, Akhmad Mustafa1, Steven Steven1
1Department of Urology, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, Indonesia.
Insights
Predicting renal function recovery after pyeloplasty for ureteropelvic junction obstruction is crucial. Preoperative differential renal function (DRF) is a key predictor, guiding treatment for chronic unilateral renal obstruction.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes Research
Background:
- Chronic unilateral renal obstruction, often due to ureteropelvic junction obstruction (UPJO), necessitates timely surgical intervention to preserve kidney function.
- Current diagnostic methods lack definitive predictors for surgical outcomes, creating challenges in treatment planning.
Purpose of the Study:
- To systematically review and identify predictors of renal function recovery following pyeloplasty in patients with UPJO.
- To inform clinical decision-making and optimize treatment strategies for chronic unilateral renal obstruction.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Literature search across PubMed, Embase, and Scopus (up to March 10, 2022) for studies on renal function, pyeloplasty, and predictors.
- Quality assessment using the Newcastle-Ottawa Scale; 11 studies (925 participants) were included.
Main Results:
- Age and gender were not significant predictors of functional recovery post-pyeloplasty.
- Preoperative differential renal function (DRF) consistently emerged as a critical predictor of renal function recovery.
- The quality of included studies was generally average, with most assessing renal function via DRF.
Conclusions:
- Preoperative DRF is a valuable predictor for renal function recovery after pyeloplasty in UPJO.
- Findings aid in understanding treatment options for chronic unilateral renal obstruction.
- Further research is required to validate identified predictors and their clinical utility.
Abstract:
Chronic unilateral renal obstruction, primarily caused by ureteropelvic junction obstruction (UPJO), poses challenges in determining the optimal timing for corrective surgery. The goal is to preserve renal function and alleviate symptoms, but there is no definitive diagnostic test to reliably predict the outcomes of surgery. This systematic review aimed to identify predictors for renal function recovery after pyeloplasty in order to guide effective treatment options. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A literature search was performed on PubMed, Embase, and Scopus using keywords related to renal function, pyeloplasty, and predictors. The search was conducted on March 10, 2022. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Out of 344 potentially relevant articles, 11 met the eligibility criteria for this study. These included 6 retrospective and 5 prospective studies, with a total of 925 participants. Most studies evaluated renal function using differential renal function (DRF). The overall quality of the included studies was considered average. The findings indicated that age at the time of surgery and gender did not significantly influence functional recovery after pyeloplasty. However, preoperative DRF consistently emerged as a critical predictor. Preoperative DRF can serve as the most common predictors used for renal function recovery following pyeloplasty. These findings contribute to understanding effective treatment options for chronic unilateral renal obstruction. However, further research for each predictor is needed to validate these predictors and their clinical utility. Cite this article as: Siregar S, Mustafa A, Steven S. Can we predict renal function recovery after pyeloplasty in pediatrics with ureteropelvic junction obstruction? A systematic review. Urol Res Pract. Published online March 31, 2024. DOI:10.5152/tud.2024.23220.
