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


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.
Sarhan
Osama
O
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Helmy
Tamer
T
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Abou-El Ghar
Mohamed
M
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Baky
Mohamed A
MA
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
El-Assmy
Ahmed
A
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Dawaba
Mohamed
M
Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011866:Radioisotope Renography; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000503:physiopathology / Q000601:surgery*