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Long-term renal function post-pyeloplasty: a systematic review
Roberto B I Christanto1, Putu Angga Risky Raharja2, Gerhard Reinaldi Situmorang1
1Department of Urology. Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Insights
Pyeloplasty surgery effectively improves or preserves kidney function in children with ureteropelvic junction obstruction (UPJO). Early intervention and minimally invasive techniques lead to the best long-term outcomes with minimal complications.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes Research
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of neonatal kidney dysfunction.
- Pyeloplasty is the standard surgical treatment, but its long-term efficacy requires further evaluation.
- Understanding long-term renal outcomes is crucial for managing pediatric UPJO.
Purpose of the Study:
- To systematically review the long-term impact of pyeloplasty on pediatric renal function.
- To assess quality-of-life and complication rates following pediatric pyeloplasty.
- To evaluate the durability of surgical correction for UPJO in children.
Main Methods:
- Systematic literature search of major databases (PubMed, Embase, Scopus, Cochrane).
- Inclusion of studies reporting long-term outcomes (≥2 years) of pediatric pyeloplasty.
- Narrative synthesis of data from 9 studies (n=836) focusing on renal function metrics and imaging.
Main Results:
- Pyeloplasty significantly improved renal function, especially in kidneys with low preoperative differential renal function (DRF).
- Up to 89% of cases showed preserved or enhanced renal function post-surgery, with frequent resolution of hydronephrosis.
- Minimally invasive pyeloplasty demonstrated efficacy comparable to open surgery, with minor complications.
Conclusions:
- Pyeloplasty offers durable success in improving or preserving renal function in pediatric UPJO.
- Antenatal diagnosis and early intervention are associated with optimal outcomes.
- Minimally invasive approaches provide benefits in recovery, and further research should focus on standardized monitoring.
Introduction:
Ureteropelvic junction obstruction (UPJO) is a significant cause of functional impairment in neonatal kidneys. The gold-standard surgical intervention for UPJO is pyeloplasty, which offers good preservation of kidney function, but long-term renal outcomes and the durability of surgical correction are not fully understood. This systematic review aims to assess the long-term impact of pyeloplasty on renal function, quality-of-life, and complication rates among pediatric patients.
Methods:
A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library was conducted to retrieve studies reporting long-term outcomes (≥ 2 years) of pediatric pyeloplasty. Inclusion criteria focused on renal function metrics including differential renal function (DRF), estimated glomerular filtration rate (eGFR), and imaging findings. 9 studies encompassing n = 836 patients met inclusion criteria. Data were synthesized narratively due to significant heterogeneity of methods and reporting.
Results:
Most studies reported significant improvements in renal function post-pyeloplasty, particularly in cases with low preoperative DRF (< 20%). DRF improvements ranged from 5 to 15%, with preservation or enhancement of renal function observed in up to 89% of cases. Hydronephrosis resolution and increases in renal parenchymal thickness were also reported frequently. Minimally invasive approaches, such as retroperitoneoscopic one-trocar-assisted pyeloplasty, showed comparable efficacy to open techniques. Complications were predominantly minor, including transient urinary infections and stent-related discomfort, with no significant long-term morbidity noted across studies.
Conclusion:
Pyeloplasty demonstrates durable success in improving or preserving renal function in pediatric patients with UPJO. Early intervention, particularly in cases diagnosed antenatally, yields the best outcomes. While all surgical techniques reviewed were effective, minimally invasive approaches offer reduced operative times and faster recovery. Further research should aim to standardize evaluation protocols and explore the use of novel biomarkers to enhance long-term patient monitoring.
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