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
References
Lee RS, Cendron M, Kinnamon DD, Nguyen HT (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118(2):586–593
Corbett HJ, Mullassery D (2015) Outcomes of endopyelotomy for pelviureteric junction obstruction in the paediatric population: a systematic review. J Pediatr Urol 11(6):328–336
Chung DY, Hong CH, Im YJ, Lee YS, Kim SW, Han SW (2015) Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: early sonographic changes that correlate with a loss of differential renal function. Korean J Urol 56(2):157–163
Tan BJ, Smith AD (2004) Ureteropelvic junction obstruction repair: when, how, what? Curr Opin Urol 14(2):55–59
Dy GW, Hsi RS, Holt SK, Lendvay TS, Gore JL, Harper JD (2016) National trends in secondary procedures following pediatric pyeloplasty. J Urol 195(42):1209–1214
Mackenzie R, Youngson G, Hussey J, Mahomed A (2002) Is there a role for balloon dilatation of pelvi-ureteric obstruction in children? J Pediatr Surg 37(6):893–896
Rohrmann D, Snyder HM, Duckett JW, Canning DA, Zderic SA (1997) The operative management of recurrent ureteropelvic junction obstruction. J Urol 158(3):1257–1259
Faerber GJ, Ritchey ML, Bloom DA (1995) Percutaneous endopyelotomy in infants and young children after failed open pyeloplasty. J Urol 154(4):1495–1497
Cromie W (1983) Complications of pyeloplasty. Urol Clin N Am 10(3):385–397
Williams DI, Kenawi M (1976) The prognosis of pelviureteric obstruction in childhood. Eur Urol 2:57–63
Kavoussi L, Meretyk S, Dierks S, Bigg S, Gup D, Manley C, Shapiro E, Clayman R (1991) Endopyelotomy for secondary ureteropelvic junction obstruction in children. J Urol 145(2):345–349
Lim DJ, Walker RDI (1996) Management of the failed pyeloplasty. J Urol 156(2):738–740
Di Grazia E, Nicolosi D (2005) Ureteroscopic laser endopyelotomy in secondary UPJ obstruction after pyeloplasty failure. Urol Int 75(4):333–336
Motola JA, Fried R, Badlani GH, Smith AD (1993) Failed endopyelotomy: implications for future surgery on the ureteropelvic junction. J Urol 150(3):821–823
Amling CL, O'Hara SM, Wiener JS, Schaeffer CS, King LR (1996) Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: long-term outcome in 47 renal units. J Urol 156(6):2020–2024. https://doi.org/10.1016/s0022-5347(01)65424-7
Bansal UK, Dangle PP, Stephany H, Durrani A, Cannon G, Schneck FX, Ost MC (2017) Optimal length of follow-up for the detection of unsuccessful pediatric pyeloplasty: a single-center experience. Front Pediatr 5:126
Ceyhan E, Ileri F, Ceylan T, Aydin AM, Dogan HS, Tekgul S (2019) Predictors of recurrence and complications in pediatric pyeloplasty. Urology 126:187–191
Thomas J, DeMarco R, Donohoe J, Adams M, Pope J, Brock J (2005) Management of the failed pyeloplasty: a contemporary review. J Urol 174(6):2363–2366
Hammady A, Elbadry MS, Rashed E-N, Moussa A, Gamal W, Dawood W, Fahmy A, Abdelkareem A, Mahfouz W (2017) Laparoscopic repyeloplasty after failed open repair of ureteropelvic junction obstruction: a case-matched multi-institutional study. Scand J Urol 51(5):402–406
Lindgren BW, Hagerty J, Meyer T, Cheng EY (2012) Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective treatment option. J Urol 188(3):932–937
Helmy TE, Sarhan OM, Hafez AT, Elsherbiny MT, Dawaba ME, Ghali AM (2009) Surgical management of failed pyeloplasty in children: single-center experience. J Pediatr Urol 5(2):87–89
Romao RL, Koyle MA, Salle JLP, Alotay A, Figueroa VH, Lorenzo AJ, Bagli DJ, Farhat WA (2013) Failed pyeloplasty in children: revisiting the unknown. Urology 82(5):1145–1149
Braga LH, Lorenzo AJ, Skeldon S, Dave S, Bagli DJ, Khoury AE, Salle JLP, Farhat WA (2007) Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol 178(6):2571–2575
Figenshau SR, Clayman RV, Colberg JW, Coplen DE, Soble JJ, Manley CB (1996) Pediatric endopyelotomy: the Washington University experience. J Urol 156(6):2025–2030
Kim EH, Tanagho YS, Traxel EJ, Austin PF, Figenshau RS, Coplen DE (2012) Endopyelotomy for pediatric ureteropelvic junction obstruction: a review of our 25-year experience. J Urol 188(4):1628–1633
Jabbour ME, Goldfischer ER, Klima WJ, Stravodimos KG, Smith AD (1998) Endopyelotomy after failed pyeloplasty: the long-term results. J Urol 160(3):690–693
Patel T, Kellner CP, Katsumi H, Gupta M (2011) Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction. J Endourol 25(4):587–591
Bernardo N, Smith A (1999) Endopyelotomy review. Arch Esp Urol 52(5):541–548
Doraiswamy N (1994) Retrograde ureteroplasty using balloon dilatation in children with pelviureteric obstruction. J Pediatr Surg 29(7):937–940
Wilkinson AG, Azmy A (1996) Balloon dilatation of the pelviureteric junction in children: early experience and pitfalls. Pediatr Radiol 26(12):882
Pohl HG, Rushton HG, Park J-s, Belman AB, Majd M (2001) Early diuresis renogram findings predict success following pyeloplasty. J Urol 165(6):2311–2315
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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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DOI: https://doi.org/10.1007/s00383-020-04699-9