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- Title
Evaluation of the outcome of pyeloplasty in children with poorly functioning kidneys due to unilateral ureteropelvic junction obstruction.
- Authors
Kapoor, Rohit; Gupta, Amit; Abbey, Pooja; Sethi, Ravinder; Yadav, Partap; Choudhury, Subhasis; Chadha, Rajiv
- Abstract
Aim: To analyze the outcome of upfront pyeloplasty in kidneys of children with unilateral ureteropelvic junction obstruction (UPJO). Materials and Methods: Thirty-three consecutive cases with split renal function (SRF) of ≤20% on dynamic renal scintigraphy (DRS) underwent upfront pyeloplasty with a nephrostomy tube and trans-anastomotic stent. Outcome was analyzed based on symptomatic relief, nephrostomy output, surgical complications and changes noted in pre-and post-operative findings on renal ultrasound (US), and DRS. Results: The most common symptom was abdominal lump in <5-year age group (79%) and abdominal pain in >5-year age group (93%). Postoperatively, symptoms were relieved in all (100%), parenchymal thickness (PT) on US improved in 82% and SRF improved significantly (>5%) in 75.8% of patients. The improvement was more significant in patients with abdominal lump and large kidneys. The mean nephrostomy output showed an inverse relationship with age at pyeloplasty and a direct correlation with the change in PT and SRF. The degree of improvement in SRF also was inversely related to the age at pyeloplasty with a significantly better outcome in <2-year-age. Although age at pyeloplasty, nephrostomy output and change in PT individually showed significant correlation with change in SRF, multiple regression analysis showed PT as the only significant factor. Conclusion: Upfront pyeloplasty should be the first option in children with poorly functioning kidneys as it has a favorable outcome in almost all the cases with a very low incidence of complications. The degree of improvement in SRF can be predicted by the nephrostomy output and improvement in PT on US.
- Subjects
KIDNEYS; URETERIC obstruction; NEPHRECTOMY; NEPHROSTOMY; TREATMENT effectiveness; RADIONUCLIDE imaging; FORECASTING; ABDOMINAL pain; CHILDREN
- Publication
Journal of Indian Association of Pediatric Surgeons, 2022, Vol 27, Issue 5, p544
- ISSN
0971-9261
- Publication type
Article
- DOI
10.4103/jiaps.jiaps_189_21