title: Does the surgical approach change the need for a retrograde pyelogram prior to pyeloplasty?
abstract: OBJECTIVE
  The opinion on the use of retrograde ureteropyelography (RUPG) prior to routine pyeloplasty for an ureteropelvic (UPJ) obstruction has been divided. This study analyses the efficacy of a preoperative RUPG and determines if a dorsal lumbotomy (DL) approach offers any advantage in this situation.
  
  
  METHODS
  This is a retrospective analysis of application of RUPG prior to pyeloplasty in children with ages ranging from 42 days to 16.2 years who underwent surgery at the Children's Hospital at Westmead between 2009 and 2013.
  
  
  RESULTS
  We identified a total of 95 children with isolated UPJ obstruction, with 59 (62.1%) boys and 36 (37.8%) girls. Overall, open pyeloplasties were performed in 89 (42 DL: 47 loin incision) and the rest (n = 6) laparoscopically. Preoperative RUPG was performed in 58 (61%) and it provided additional information in 11 (18.9%) patients for whom the surgical approach was modified. Hospital stay, operative time, and time to full diet were shorter with the DL approach (p < 0.05).
  
  
  CONCLUSIONS
  The current study suggests that RUPG is avoidable if the approach for pyeloplasty is through the conventional loin incision. The short-term advantages might rationalize the use of RUPG if a DL incision is employed.
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia. Electronic address: drsharat77@gmail.com.
authors.forename: Sarath Kumar
authors.initials: SK
authors.lastname: Narayanan
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia.
authors.forename: Grahame
authors.initials: G
authors.lastname: Smith
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia.
authors.forename: Ralph Clinton
authors.initials: RC
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000000981:diagnostic imaging* / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011300:Preoperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery*; D014567:Urography
keywords: Dorsal lumbotomy; Pediatric; Pyeloplasty; Retrograde ureteropyelography; Ureteropelvic junction obstruction