OUTCOME OF PYELOPLASTY IN CHILDREN

Authors

  • Muhammad Siddique
  • Mudassar Saeed Pansota
  • Muhammad Shahzad Saleem
  • Attique -ur- Rehman

Abstract

Background: Hydronephrosis in children is a common congenital urologic problem with pelviureteric junction obstruction being its most common cause. This study was conducted to evaluate the outcome of pyeloplasty for congenital pelviureteric junction obstruction in children. Methods: This study was conducted in department of Paediatric Surgery, Quaid-e-Azam Medical College/Bahawal Victoria Hospital, Bahawalpur from July 2008 to December 2010. A total of 50 patients diagnosed on ultrasonography and intravenous urogram as having PUJ obstruction were included. Patients with history of previous repair were excluded. Both Dismembered (Anderson Hynes) and Non-dismembered (Flap procedures) pyeloplasties were performed depending upon the size of pelvis and degree of dilatation. Initial follow-up was after 1 week, then after 15 days and then monthly for 3 months. Minimum follow-up period was 6 months and maximum 15 months. At three month, excretory urography was obtained to assess the function of that particular renal unit. Results: Lumbar pain and flank mass were the commonest presenting complaints. Thirty-six (72%) patients were male. Left sided obstruction was in 32 (64%) cases, right-sided in 15 (30%), and 3 (6%) cases were bilateral. Common post-operative complications were urinoma formation and re-stenosis in two cases each. There was also no gross difference of outcome in pyeloplasty whether done with or without double-J (DJ) stents. Moreover, dismembered pyeloplasty resulted in better outcome. Conclusions: Open pyeloplasty is the “Gold Standard” treatment option for congenital pelviureteric junction obstruction. The use of DJ Stents is not necessary in every repair.Keywords: Pelviureteric junction Obstruction, Ultrasonography, intravenous urogram, dismembered pyeloplasty, non-dismembered, pyeloplasty, DJ Stent

References

Chandrasekharam VV, Srinivas M, Bal CS, Gupta AK, Agarwala S, Mitra DK, et al. Functional outcome after pyeloplasty for unilateral symptomatic hydronephrosis. Pediatr Surg Int 2001;17:524–7.

Kato Y, Yamataka A, Okazaki T, Yanai T, Lane GJ, Kobayashi H, et al. Surgical treatment and outcome of mega-hydronephrosis due to PUJ stenosis. Pediatr Surg Int 2006;22:911–3.

Chertin B, Puri P. Pyeloplasty. Springer Surg Atlas Series, 2005;8:485–92.

Valayer J, Adda G. Hydronephrosis due to pelviureteric junction in infancy. Br J Urol 1982;54:451–4.

Bejjani B. Belman AB. Ureteropelvic junction obstruction in newborn and infants. J Urol 1982;128:770–3.

Chevalier RL, El Dahr S. The case for early relief of obstruction in young infants. In: King LR, editor. Urological surgery in neonates and young infants. Philadelphia: WB Saunders; 1988.p. 95–118.

Culp OS, Deweerd JH. A pelvic flap operation for certain types of uretero-pelvic strictures. Preliminary report. Proc Staff Meet Mayo Clin 1951;26:483–8.

Scardino PL, Prince CL. Vertical flap ureteropelvioplasty: Preliminary report. South Med J 1953;46:325–31.

Foley FE. A new plastic operation for stricture at the ureteropelvic junction. J Urol 2002;167(2 Pt 2):1075–95.

Culp OS, Deweerd J. A pelvic flap operation for certain types of ureteropelvic obstruction: Observations after two years’ experience. J Urol 1954;71:523–9.

Prince CL, Scardino PL. Results of various procedures used for correction of congenital ureteropelvic obstruction. J Urol 1962;87:315–8.

Devine CJ Jr, Devine PC, Prizzi AR. Advancing V-flap modification for the dismembered pyeloplasty. J Urol 1970;104:810–6.

Diamond DA, Nguyen HT. Dismembered V-flap pyeloplasty. J Urol 2001;166:233–5.

Anderson JC, Hynes W. Retrocaval ureter. Br J Urol 1949;21:209–14.

O’Reilly PH. Functional outcome of pyeloplasty for ureteropelvic junction obstruction; prospective study in 30 consecutive cases. J Urol 1989;142 (2 Pt 1):273–6.

Houben CH, Wischermann A, Borner G, Slany E. Outcome Analysis of pyeloplasty in infents. Pediatr Surg Int 2006;16:189–93.

Pohl HG, Rushton HG, Park JS, Belman AB, Majd M. Early diuresis renogram findings predict success following pyeloplasty. J Urol 2001;165:2311–5.

Konda R, Sakai K, Ota S, Abe Y, Hatakeyama T, Orikasa S. Ultrasoungradof hydronephrosis and severity of renal cortical damage on 99m technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty. J Urol 2002;167:2159–63.

Austin PF, Cain MP, Rink RC. Nephrostomy tube drainage with pyeloplasty: is it necessarily a bad choice? J Urol 2000;163:1528–30.

Tal R, Bar Sever Z, Livne PM. Dismembered Pyelplasty in Children: A Review of 5 years single centre experience. Int J Urol 2005;12:1028–31.

Koff SA, Thrall JH, Keyes JW Jr. Diuretic radionucleoide urography: A non invasive method for evaluating nephroureteral dilatation. J Urol 2002;167(2 Pt 2):1044–7.

Yurkanin JP, Fuchs GJ. Laproscopic dismembered pyeloureteroplasty: A single institution’s 3-year experience. J Endourol 2004;18:765–9.

Valla JS, Breaud J, Griffin SJ, Sautot-Vial N, Beretta F, Guana R, et al. Retroperitoneoscopic vs open dismembered pyeloplasty for ureteropelvic junction obstruction in children. J Peadr Urol 2009;5:368–73.

Yee DS, Shanberg AM, Duel BP, Rodriguez E, Eichel L, Rajpoot D. Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children. Urology 2006;67:599–602.

Ravish IR, Nerli RB, Reddy MN, Amarkhed SS. Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol 2007;21:897–902.

Bonnard A, Fouquet V, Carricaburu E, Aigrain Y, El-Ghoneimi A. Retroperitoneal laparoscopic versus open pyeloplasty in children. J Urol 2005;173:1710–3.

Allen TD. Congenital ureteral strictures. J Urol 1970;104:196–204.

Smith KE, Holmes N, Lieb JI, Mandell J, Baskin LS, Kogan BA et al. Stented versus nonstented pediatric pyeloplasty: a modern series and review of the literature. J Urol 2002;168:1127–30.

Elmalik K, Chowdhury MM, Capps SN. Ureteric stents in pyeloplasty: a help or a hindrance. J Pediatr Urol 2008;4(4):275–9.

Jabbour ME, Goldfischer ER, Klima WJ, Stravodimos KG., Smith AD. Endopyelotomy after failed pyeloplasty, the long term results. J Urol 1998;160(3 Pt1):690–2.

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Published

2014-03-01