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MANAGEMENT OF THE FAILED PYELOPLASTY: A CONTEMPORARY REVIEW

2005; Lippincott Williams & Wilkins; Volume: 174; Issue: 6 Linguagem: Inglês

10.1097/01.ju.0000180420.11915.31

1527-3792

John Thomas, Romano T. DeMarco, Jeffrey M. Donohoe, M.C. ADAMS, John C. Pope, John W. Brock,

Congenital gastrointestinal and neural anomalies

No AccessJournal of UrologyPediatric Urology1 Dec 2005MANAGEMENT OF THE FAILED PYELOPLASTY: A CONTEMPORARY REVIEW J.C. THOMAS, R.T. DeMARCO, J.M. DONOHOE, M.C. ADAMS, J.C. POPE, and J.W. BROCK J.C. THOMASJ.C. THOMAS , R.T. DeMARCOR.T. DeMARCO , J.M. DONOHOEJ.M. DONOHOE , M.C. ADAMSM.C. ADAMS , J.C. POPEJ.C. POPE , and J.W. BROCKJ.W. BROCK View All Author Informationhttps://doi.org/10.1097/01.ju.0000180420.11915.31AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed our experience with open dismembered pyeloplasty, with specific focus on the presentation and management of failed pyeloplasty in the pediatric population. Materials and Methods: We performed a retrospective review of patients who had undergone open dismembered pyeloplasty between 1998 and 2003. All patients with less than 6 months of followup were excluded from analysis. The patients were followed postoperatively with serial ultrasounds, with renograms reserved for those patients with prolonged, persistent or worsening hydronephrosis, or recurrent symptoms during followup. Results: A total of 105 pyeloplasties were performed in 103 patients (71 males and 32 females) 1 to 204 months old (mean 60), with an overall success rate of 93.3%. Followup ranged from 6 to 69 months (mean 23). The 7 patients with treatment failure were males 1 to 204 months old (mean 125), who presented most commonly with pain within 3 to 38 months (mean 13.1) after initial surgery. Subsequent ultrasound revealed worsening hydronephrosis, and renography in these patients showed a pattern consistent with obstruction. Five patients underwent initial balloon dilation, in which 1 was successful. In addition, 1 of these patients underwent an unsuccessful antegrade laser endopyelotomy. Six patients (86%) underwent open surgery, consisting of ureterocalicostomy in 3 and reoperative dismembered pyeloplasty in 3. Dense scarring was seen in all patients, 2 patients had a redundant pelvis causing kinking and 2 patients had unrecognized crossing vessels. Overall salvage rate was 100% with continued followup of 3 to 50 months (mean 18). Conclusions: Dismembered pyeloplasty was successful in the vast majority of patients. In our series failures occurred as late as 3 years postoperatively, although most presented within 12 months of followup. Excluding routine postoperative nuclear renography did not seem to affect our ability to identify these cases. Although anatomical features such as renal pelvic size may have a role, failure is most likely secondary to technical issues, including missed crossing vessels and dependency of the anastomosis. In this series failed pyeloplasties did not respond well to balloon dilation, likely due to scar formation. 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Volume 174Issue 6December 2005Page: 2363-2366 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsblood vesselsureteral obstructiontreatment failurepediatricsurologic surgical proceduresMetricsAuthor Information J.C. THOMAS More articles by this author R.T. DeMARCO More articles by this author J.M. DONOHOE More articles by this author M.C. ADAMS More articles by this author J.C. POPE More articles by this author J.W. BROCK More articles by this author Expand All Advertisement PDF downloadLoading ...