Abstract
Introduction
Pyeloplasty is the definitive management of ureteropelvic junction obstruction (UPJO). One of the challenging questions is when to perform pyeloplasty. We studied if improvement post-pyeloplasty in the first 3 months of life could show greater improvement in hydronephrosis than surgery at an older age.
Patients and Methods
Patients with postnatally diagnosed UPJO and underwent pyeloplasty in the first year of life were retrospectively reviewed. We excluded patients with concomitant vesicoureteral reflux, and patients who had pyeloplasty because of UTI or missed follow-up. Patients were divided into two groups, according to the age at pyeloplasty, before and after the age of 3 months. We collected patients’ demographics, anteroposterior diameter of the renal pelvis (APD), SFU grade, renogram data, perioperative data (surgery duration, hospital stay, and ureteral stent duration) and postoperative ultrasound changes. The percentage of change of APD (Δ%APD) was calculatedusing the formula: Δ%APD = [ (initial APD-last APD)/initial APD] *100.
Results
We included 90 patients (93 renal units). 36 patients had pyeloplasty during the first 3 months of life and 57 patients at 3 -12 months. Patients’ characteristics were similar in both groups except APD which was higher when pyeloplasty was done < 3 months of age (p = 0.02). Both groups had comparable perioperative parameters. After almost similar follow-up period of both groups. The Δ%APD was 58% when pyeloplasty was done < 3 months compared to 33% when was performed > 3 months (p = 0.009). Using Kaplan–Meier analysis, APD significantly improved when pyeloplasty was performed before the age of 3 months (p = 0.001).
Conclusion
Early pyeloplasty, in the first 3 months of life, showed a significant improvement of APD postoperatively than those had surgery later. It is unclear if this will relate to less loss of renal function yet certainly this would be suspected and feel this finding provides some evidence for early intervention.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Data are not available due to the ownership rights of the healthcare center where data were collected. The corresponding author could be contacted if data clarification is warranted.
References
Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P et al (2010) The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 6(3):212–231
Jiang D, Tang B, Xu M, Lin H, Jin L, He L et al (2017) Functional and Morphological Outcomes of Pyeloplasty at Different Ages in Prenatally Diagnosed Society of Fetal Urology Grades 3–4 Ureteropelvic Junction Obstruction: Is It Safe to Wait? Urology 101:45–49
Hodhod A, Capolicchio JP, Jednak R, Eid H, El-Doray AE, El-Sherbiny M (2018) Is the renal pyramidal thickness a good predictor for pyeloplasty in postnatal hydronephrosis? J Pediatr Urol 14(3):277
Tabari AK, Atqiaee K, Mohajerzadeh L, Rouzrokh M, Ghoroubi J, Alam A et al (2020) Early pyeloplasty versus conservative management of severe ureteropelvic junction obstruction in asymptomatic infants. J Pediatr Surg 55(9):1936–1940
Babu R, Rathish VR, Sai V (2015) Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi-ureteric junction obstruction. J Pediatr Urol 11(2):63
Romao RL, Farhat WA, Pippi Salle JL, Braga LH, Figueroa V, Bagli DJ et al (2012) Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction. J Urol 188(6):2347–2353
Hodhod A, Turpin S, Petrella F, Jednak R, El-Sherbiny M, Capolicchio JP (2021) Validation of modified diuretic drainage times criteria in congenital hydronephrosis. J Pediatr Urol 17(6):832
Capolicchio G, Leonard MP, Wong C, Jednak R, Brzezinski A, Salle JL (1999) Prenatal diagnosis of hydronephrosis: impact on renal function and its recovery after pyeloplasty. J Urol 162(3 Pt 2):1029–1032
Simforoosh N, Abedi A, Hosseini Sharifi SH, Poor Zamany NKM, Rezaeetalab GH, Obayd K et al (2014) Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age. J Pediatr Urol 10(5):819–823
Chandrasekharam VV, Srinivas M, Bal CS, Gupta AK, Agarwala S, Mitra DK et al (2001) Functional outcome after pyeloplasty for unilateral symptomatic hydronephrosis. Pediatr Surg Int 17(7):524–527
Ing C, Wall MM, DiMaggio CJ, Whitehouse AJO, Hegarty MK, Sun M et al (2017) Latent Class Analysis of Neurodevelopmental Deficit After Exposure to Anesthesia in Early Childhood. J Neurosurg Anesthesiol 29(3):264–273
Ing C, DiMaggio C, Whitehouse A, Hegarty MK, Brady J, von Ungern-Sternberg BS et al (2012) Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics 130(3):e476–e485
Brockel MA, Polaner DM, Vemulakonda VM (2018) Anesthesia in the Pediatric Patient. Urol Clin North Am 45(4):551–560
Sutherland RW, Chung SK, Roth DR, Gonzales ET (1997) Pediatric pyeloplasty: outcome analysis based on patient age and surgical technique. Urology 50(6):963–966
Hodhod A, Eid H, Capolicchio JP, Petrella F, Sadri I, El-Sherbiny M et al (2023) How can we measure the renal pelvic anteroposterior diameter in postnatal isolated hydronephrosis? J Pediatr Urol 19(1):75–82
Dias CS, Silva JM, Pereira AK, Marino VS, Silva LA, Coelho AM et al (2013) Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol 190(2):661–666
Kajbafzadeh AM, Payabvash S, Salmasi AH, Monajemzadeh M, Tavangar SM (2006) Smooth muscle cell apoptosis and defective neural development in congenital ureteropelvic junction obstruction. J Urol 176(2):718–723
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
Braga LH, Lorenzo AJ, Bagli DJ, Keays M, Farhat WA, Khoury AE et al (2008) Risk factors for recurrent ureteropelvic junction obstruction after open pyeloplasty in a large pediatric cohort. J Urol 180(4 Suppl):1684–1687
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
Nordenstrom J, Koutozi G, Holmdahl G, Abrahamsson K, Sixt R, Sjostrom S (2020) Changes in differential renal function after pyeloplasty in infants and children. J Pediatr Urol 16(3):329
Funding
None
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests
None
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Hodhod, A., Eid, H., Fermin-Risso, C. et al. Significant improvement in hydronephrosis with pyeloplasty prior to 3 months of age in patients with antenatal severe hydronephrosis. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04002-y
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11255-024-04002-y