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Pyeloplasty is a safe and effective surgical approach for low functioning kidneys with ureteropelvic junction obstruction

  • Author Footnotes
    1 Co-first author.
    Diana K. Bowen
    Footnotes
    1 Co-first author.
    Affiliations
    Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA
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  • Author Footnotes
    1 Co-first author.
    Sameer Mittal
    Footnotes
    1 Co-first author.
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA, 19104, USA
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  • Aznive Aghababian
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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  • Sahar Eftekharzadeh
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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  • Lauren Dinardo
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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  • John Weaver
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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  • Christopher Long
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA, 19104, USA
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  • Aseem Shukla
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA, 19104, USA
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  • Arun K. Srinivasan
    Correspondence
    Correspondence to: Arun Srinivasan, Department of Surgery/Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd Wood 3rd Floor Philadelphia, PA, 19104, USA, Tel.: (267) 825 4751 Fax: +267 426 7335
    Affiliations
    Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Philadelphia, PA, 19104, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-first author.
Published:December 19, 2020DOI:https://doi.org/10.1016/j.jpurol.2020.12.018

      Summary

      Introduction

      Indications for treatment of ureteropelvic junction obstruction (UPJO) include symptomatic obstruction, urinary tract infections, presence of an obstructive pattern on functional renal scan and/or worsening differential renal function (DRF). This paper aims to determine the relationship between preoperative DRF and surgical outcomes after pyeloplasty. We hypothesized that low preoperative DRF is not an independent predictor of pyeloplasty failure.

      Methods

      A retrospective chart review was performed to identify all patients undergoing pyeloplasty for UPJO between 2008 and 2019. Patients were included only if they had at least one preoperative functional scan and a minimum of one renal ultrasound post-operatively. Patients were divided into three groups based on DRF for analysis: Group 1- 0-10%, Group 2 - >10-≤20%, Group 3 - >20%. Baseline, intraoperative and postoperative characteristics, including success and complications were compared. Additional sensitivity analyses were performed comparing patients with ≤20%, and >20% function, ≤30%, and >30% function as well as an analysis of patients undergoing only minimally invasive reconstruction.

      Results

      Three hundred and sixty-four patients met inclusion criteria. We identified 8 patients in Group 1, 24 patients in Group 2 and 332 patients in Group 3. Mean procedure time was longest for the ≤10% function group (237.9 vs 206.4 vs 189.1; p = 0.01). We found no difference in 30-day post-operative complications, overall success rate or the need for additional procedures among the three groups. For patients in Group 1, we noted variation in the post-procedure DRF with a range of −2.8 to +47% change. In this group, none of patients with low DRF underwent nephrectomy. Multivariate logistic regression did not identify renal function as a predictor of operative success OR 1.00 (95% CI: 0.97–1.03) (p-value: 0.88).

      Discussion

      The results of the present study suggest that low DRF alone is not associated with worse outcomes and shows no difference in the failure rate. The incidence and type of complications were not increased for the lower functioning groups. The main limitation of this study would be its retrospective nature and single-institution experience. Furthermore, post-operative functional studies were not available for all patients, limiting the ability to draw conclusions on the change in DRF after surgery.

      Conclusions

      Summary TableSurgical outcomes after pyeloplasty categorized by baseline renal function.
      Factor, N (%) Preoperative renal function p-value
      Group 1 0-10% Group 2 >10% - ≤20% Group 3 >20%
      N 8 24 332
      Technique 0.40
      Robotic-Assisted 8 (100.0%) 19 (79.2%) 256 (77.1%)
      Open 0 (0.0%) 4 (16.7%) 70 (21.1%)
      Laparoscopic 0 (0.0%) 1 (4.2%) 6 (1.8%)
      Post-operative Complications 1 (12.5%) 4 (16.7%) 51 (15.4%) 0.91
      Grade 1 0 (0.0%) 2 (50.0%) 13 (25.5%) 0.75
      Grade 2 1 (100.0%) 2 (50.0%) 23 (45.1%)
      Grade 3a 0 (0.0%) 0 (0.0%) 1 (2.0%)
      Grade 3b 0 (0.0%) 0 (0.0%) 13 (25.5%)
      Grade 4a 0 (0.0%) 0 (0.0%) 1 (2.0%)
      Overall success 8 (100.0%) 23 (95.8%) 311 (93.7%) 1.00
       Asymptomatic after surgery 8 (100%) 23 (95.8%) 314 (94.6%) 1.00
       Unimproved hydronephrosis 0 (0.0%) 1 (0%) 21 (6.3%) 0.72
       Additional endoscopic procedure 0 (0.0%) 1 (4.2%) 19 (5.7%) 1.00
       Underwent redo reconstruction 0 (0.0%) 1 (4.2%) 12 (4.2%) 1.00

      Keywords

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