title: Outcomes of Pyeloplasty in Very Poorly Functioning Kidneys: Examining the Myths.
abstract: OBJECTIVE
  To assess the perioperative complications and functional midterm outcomes after pyeloplasty for poorly functioning kidneys due to ureteropelvic junction obstruction.
  
  
  METHODS
  We retrospectively analyzed patients who underwent pyeloplasty for primary ureteropelvic junction obstruction in very poorly functioning kidneys in terms of split renal function of ≤20% or estimated glomerular filteration rate of ≤20 mL/minute. Perioperative complications and postoperative outcomes in terms of symptomatic improvement and functional stabilization or recovery were assessed.
  
  
  RESULTS
  A total of 32 patients with estimated glomerular filteration rate ≤20 mL/minute or split function ≤20% underwent pyeloplasty since January 2010. All patients were followed for a mean period of 26.8 months and none required reintervention for obstructive drainage, deteriorating function, or intractable pain. One patient had persistent pain requiring analgesics and overall success rate (defined as nonobstructive pattern, no deterioration in split function, and no persistent symptoms) was 93.7%. Thirteen patients (40.6%) showed significant improvement in renal function (>5% over preoperative), and in all except 1 (3.1%) case there was no further deterioration of function.
  
  
  CONCLUSIONS
  Pyeloplasty provides high rates of morphological and functional success even in very poorly functioning renal units. There is a possibility of functional recovery in one-third of patients, and in most of the rest, there is no further deterioration.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: nayyarrishi@gmail.com.
authors.forename: Rishi
authors.initials: R
authors.lastname: Nayyar
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Yadav
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prem Nath
authors.initials: PN
authors.lastname: Dogra
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery; D007668:Kidney / Q000503:physiopathology; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D021782:Multicystic Dysplastic Kidney / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000503:physiopathology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult