Long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction in adults associated with renal congenital anomalies: Age, sex and renal function matched analysis

• Published in: Arab Journal of Urology 2021-04, Vol.19 (2), p.173-178
• Main Authors: Elbaset, Mohamed A., Osman, Yasser, Elgamal, Mostafa, Sharaf, Mohamed A., Ezzat, Osama, Elmeniar, Ali M., Abdelhamid, Abdalla, Zahran, Mohamad H.
• Format: Article
• Language: English
• Subjects: congenital renal anomalies; crossed fused kidney; duplex; ectopic kidney; horseshoe kidney; Pelvi-ureteric junction obstruction (PUJO); pyeloplasty; Reconstruction; renal function
• ISSN: 2090-598X; 2090-598X; 2090-5998
• DOI: 10.1080/2090598X.2020.1816600

Objective: To assess the long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction (PUJO) associated with renal anomalies. Patients and methods: Data were collected for patients after pyeloplasty for PUJO associated with renal anomalies and analysed retrospectively. Long-term functional success was evaluated by comparing the renographic split renal function (SRF) and glomerular filtration rate (GFR) at last follow-up with baseline values. A change of 5% in SRF was considered significant. Factors affecting functional outcome were assessed. The outcomes were compared to an age, sex and renal function matched group with PUJO in otherwise normal kidneys (Group 2) to evaluate the pattern of difference in functional recoverability in both groups. This was assessed using repeated-measures analysis of variance. Results: The study initially included 70 adult patients, with a mean age of 31.8 years. At a median of 44 months, 55 patients completed follow-up (Group 1) and no statistically significant changes in GFR (P = 0.7) and SRF (P = 0.06) were found. In all, 17, four and 34 patients showed a decrease, increase and static SRF (functional success rate was 69%). Higher preoperative SRF (P = 0.02) and Anderson-Hynes (A-H) pyeloplasty (P = 0.003) were associated with functional preservation. In the comparison with the other matched group (Group 2), the patients in Group 2 had better functional recoverability after pyeloplasty than patients with associated anomalies [GFR (P = 0.001), SRF (P = 0.002) and functional success (P = 0.001)]. Conclusion: Functional preservation after pyeloplasty in associated renal anomalies could be achieved in 69% of patients, which was significantly lower than those with otherwise normal kidneys. A-H pyeloplasty and higher preoperative SRF were associated with better functional outcomes. Abbreviations: A-H: Anderson-Hynes; HSK: horseshoe kidneys; OR: odds ratio; PUJO: PUJ obstruction; SRF: split renal function; T 1/2 , half-time