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Pediatric pyeloplasty: outcome analysis based on patient age and surgical technique
R W Sutherland1, S K Chung, D R Roth
1Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Open pyeloplasty is an effective surgical technique for all age groups, demonstrating excellent outcomes and a low complication rate. This study highlights its success in treating pediatric ureteropelvic junction obstruction.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Urological Reconstruction
Background:
- Ureteropelvic junction (UPJ) obstruction is a common congenital anomaly in children.
- Pyeloplasty remains the gold standard surgical treatment for UPJ obstruction.
- Open pyeloplasty has been a widely used technique, with evolving approaches and outcomes.
Purpose of the Study:
- To evaluate the outcomes of open pyeloplasty.
- To analyze the impact of patient age on surgical results.
- To assess complication rates and management strategies in open pyeloplasty.
Main Methods:
- Retrospective review of 234 open pyeloplasties performed between 1974 and 1994.
- Analysis of patient demographics, presenting symptoms, surgical techniques, and postoperative outcomes.
- Stratification of results based on patient age (infants vs. older children).
Main Results:
- A total of 227 patients underwent 234 pyeloplasties, with increasing use of pyeloplasty in younger infants over time.
- Presenting symptoms varied by age, with prenatal ultrasound findings common in infants and pain in older children.
- Dismembered, nonintubated pyeloplasty yielded high success rates (95-96%) across both age groups.
- Overall complication rate was 7.7% for urinary tract infections, 2.1% for recurrent obstruction, and 1.7% for persistent leak, with no age-related difference.
Conclusions:
- Nonintubated, dismembered open pyeloplasty is a safe and effective procedure for UPJ obstruction in all pediatric age groups.
- The technique is associated with a low complication rate and excellent long-term outcomes.
- This approach provides a reliable surgical solution for pediatric UPJ obstruction.
Objectives:
To analyze our experience with open pyeloplasty, with specific emphasis on procedural outcome on the basis of patient age, surgical technique, complication rate, and complication management.
Methods:
All patients from 1974 to 1994 who underwent pyeloplasty at our institution were included in our review. Charts were analyzed for age at presentation, presenting signs and symptoms, type of surgical reconstruction, complications and treatment, and final outcome.
Results:
From 1974 to 1994, 234 pyeloplasties were performed in 227 patients (108 less than 1 year old, 119 more than 1 year old). The percentage of children less than 1 year old increased throughout: 24% for 1975 to 1980, 37% for 1981 to 1990, and 69% for 1991 to 1994. Presenting signs and symptoms varied according to the age of the child at pyeloplasty. For children less than 1 year old, these were prenatal ultrasound in 86 (79%), urinary tract infection (UTI) in 9 (8%), and abdominal mass in 5 (4.6%). For children more than 1 year old, these were pain in 57 (48%), UTI in 29 (24%), hematuria in 12 (10%), and prenatal ultrasound in 3 (2.5%). Reconstruction was a dismembered pyeloplasty in all cases. The majority of patients in both age groups underwent a nonintubated repair (less than 1 year old, 99 of 114; more than 1 year old, 102 of 120). Postoperative results were evaluated by ultrasound or intravenous urography, with improvement or stable results in 95% of children less than 1 year old and in 96% of children more than 1 year old. Complications included UTI in 18 patients (7.7%), recurrent obstruction in 5 (2.1%), and persistent leak in 4 (1.7%). The complication rate was not related to age.
Conclusions:
The nonintubated, dismembered pyeloplasty is an excellent technique for all age groups and has a low complication rate.