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Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
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Functional outcomes of pyeloplasty in children with reduced preoperative renal function: A multicenter study

S Tobía González1, A Bujons-Tur2, J P Corbetta3

  • 1Hospital Interzonal de Agudos Especializado en Pediatría Sor María Ludovica, La Plata, Argentina.

Actas Urologicas Espanolas
|May 26, 2026
PubMed

Insights

Pyeloplasty effectively stabilizes or improves kidney function in children with ureteropelvic junction obstruction (UPJO) and reduced differential renal function (DRF). Prenatal hydronephrosis indicates a higher risk of postoperative decline.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Outcomes

Background:

  • Ureteropelvic junction obstruction (UPJO) is a common cause of pediatric kidney issues.
  • Reduced preoperative differential renal function (DRF) in UPJO presents a challenge for surgical outcomes.
  • Dismembered pyeloplasty is a standard surgical treatment for UPJO.

Purpose of the Study:

  • To assess functional outcomes of dismembered pyeloplasty in children with unilateral UPJO and preoperative DRF ≤40%.
  • To identify factors influencing renal function post-pyeloplasty in this cohort.

Main Methods:

  • Retrospective multicenter review of 74 children with unilateral UPJO and DRF ≤40% (2003-2022).
  • Patients were divided into two groups based on preoperative DRF: <20% (Group 1) and 20-40% (Group 2).
  • Exclusion criteria included bilateral UPJO, solitary kidney, secondary causes, prior surgery, and follow-up <1 year.

Main Results:

  • Overall DRF improved from a median of 26% to 36.9% postoperatively (p<0.001).
  • Functional improvement (>5%) was observed in 58.1% of patients (73.9% in Group 1 vs. 51.0% in Group 2).
  • 93.2% of patients showed stable or improved DRF, with prenatal hydronephrosis predicting postoperative decline (OR 7.12).

Conclusions:

  • Dismembered pyeloplasty leads to stabilization or improvement in renal function for children with UPJO and reduced preoperative DRF, even when DRF is <20%.
  • Prenatal hydronephrosis is a significant predictor of poorer functional outcomes after pyeloplasty.
  • These findings support pyeloplasty as an effective treatment for UPJO with compromised renal function.
Abstract

Keywords:
Differential renal functionFunción renal diferencialHidronefrosis prenatalObstrucción pieloureteralPediatricsPediatríaPieloplastiaPrenatal hydronephrosisPyeloplastyUreteropelvic junction obstruction

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