Post-pubertal stability of split renal function after pyeloplasty performed in childhood

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Outcomes

Background:

• Long-term split renal function (SRF) stability after pyeloplasty in children, especially post-puberty, is not well understood.
• Early outcomes are documented, but late functional changes require further investigation.

Purpose of the Study:

• To evaluate long-term SRF stability after prepubertal pyeloplasty.
• To identify factors predicting late SRF deterioration beyond puberty.

Main Methods:

• Retrospective review of pediatric patients undergoing pyeloplasty (2000-2025).
• Exclusion of patients with solitary kidney, prior surgery, or congenital anomalies.
• Categorization into groups based on >=5% SRF decrease post-puberty; comparison of clinical, surgical, and imaging parameters using statistical tests and multivariate logistic regression.

Main Results:

• 191 patients included; 20.4% experienced late SRF deterioration.
• Younger age at surgery, renal pelvis reduction, and persistent hydronephrosis at 1 year were associated with deterioration (p < 0.001).
• Renal pelvis reduction (OR=9.82) and persistent hydronephrosis (OR=4.811) predicted deterioration; older age and higher final SRF were protective.

Conclusions:

• Split renal function (SRF) may deteriorate after puberty despite initial stability post-pyeloplasty.
• Factors like renal pelvis reduction, persistent hydronephrosis, and younger age at surgery increase deterioration risk.
• Older age at surgery and higher final SRF demonstrate a protective effect against late SRF decline.