Long-term functional and morphological outcome after pyeloplasty for huge renal pelvis

Authors


Osama M. Sarhan, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt. e-mail: o_sarhan2004@yahoo.com

Abstract

Study Type – Therapy (case series)

Level of Evidence 4

OBJECTIVE

• To evaluate the functional and morphological outcome after open pyeloplasty for ureteropelvic junction obstruction (UPJO) with huge renal pelvis.

PATIENTS AND METHODS

• A retrospective review of all cases who underwent pyeloplasty for huge renal pelvis was conducted.

• Records were evaluated with respect to age at presentation, preoperative imaging, surgical details and postoperative course. Patients were followed up regularly for both functional and morphological outcome.

• Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow-up.

RESULTS

• Between 1998 and 2008, 526 cases of primary UPJO underwent open dismembered pyeloplasty at our centre.

• Of these patients, 41 (8%) had UPJO with huge renal pelvis.

• No perioperative complications were encountered in the study group. Mean (range) follow-up was 34 (18–84) months and nine patients were lost to follow-up. The overall success rate was 91%.

• Two patients underwent redo pyeloplasty, whereas secondary nephrectomy was necessary in one.

• Improvement of hydronephrosis was evident in all patients, except in three patients who underwent secondary procedures.

• However, persistent obstruction on diuretic renography was seen in most cases (65%).

CONCLUSIONS

• Open pyeloplasty for huge pelvis UPJO is feasible with a high success rate.

• Varying degrees of hydronephrosis and radiological obstruction after pyeloplasty are not uncommon.

• Nephrectomy is rarely indicated in cases with severely deteriorated renal function.

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