Our experience on management of failed pediatric pyeloplasty

Abstract

Purpose

The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention.

Methods

40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation.

Results

Children’s mean age at initial intervention for failed pyeloplasty was 45.9 (± 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (± 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05).

Conclusions

Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.

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Abbreviations

UPJO:

Ureteropelvic junction obstruction

DJS:

Double J stent

PCN:

Percutaneous nephrostomy

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Correspondence to Erman Ceyhan.

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Ceyhan, E., Dogan, H.S. & Tekgul, S. Our experience on management of failed pediatric pyeloplasty. Pediatr Surg Int 36, 971–976 (2020). https://doi.org/10.1007/s00383-020-04699-9

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Keywords

  • Hydronephrosis
  • Recurrence
  • Dilatation
  • Follow-up studies
  • Child