title: Critical analysis of outcome after open dismembered pyeloplasty in ectopic pelvic kidneys in a pediatric cohort.
abstract: OBJECTIVE
  To evaluate the functional and morphologic outcome after open pyeloplasty for ureteropelvic junction obstruction (UPJO) in ectopic pelvic kidneys.
  
  
  METHODS
  A retrospective review of all patients who underwent open pyeloplasty in ectopic pelvic kidneys was conducted. Records were evaluated with respect to age at presentation, preoperative imaging, surgical details, and postoperative course. Patients were followed up regularly for functional and morphologic outcome. Success was defined as symptomatic relief and radiographic improvement of obstruction at the last follow-up.
  
  
  RESULTS
  Between 1995 and 2010, 680 patients with primary UPJO underwent open dismembered pyeloplasty at our center. Of these patients, 43 (6.3%) had UPJO in ectopic pelvic kidneys. No perioperative complications were encountered in the study group. Mean follow-up was 42 months (range, 18-90 months), and 5 patients were lost to follow-up. The overall success rate was 82.6%. Postoperative hydronephrosis was improved in 20 (52.6%), stable in 11 (29%), and worsened in 7 (18.4%). Postoperative renal function was improved in 12 (31.6%), stable in 19 (50%), and deteriorated in 7 (18.4%). Redo pyeloplasty was required in 4 patients and secondary nephrectomy in 3. Preoperative differential renal function and surgeon experience were statistically significant predictors of improvement in renal function after pyeloplasty.
  
  
  CONCLUSIONS
  Open pyeloplasty for UPJO in ectopic pelvic kidneys is feasible, but varying degrees of hydronephrosis and radiologic obstruction persist after pyeloplasty that could be attributed to anatomy-related pelvocaliectasis, and so regular follow-up is warranted in this subpopulation.
authors.affiliation: Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt. drthelmy@yahoo.com
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.forename: Osama M
authors.initials: OM
authors.lastname: Sarhan
authors.forename: Doaa E
authors.initials: DE
authors.lastname: Sharaf
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Shalaby
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Harraz
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
authors.forename: Mohammed E
authors.initials: ME
authors.lastname: Dawaba
mesh_terms: D002648:Child; D002675:Child, Preschool; D002828:Choristoma / Q000150:complications*; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007223:Infant; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*