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Risk Factors for Recurrent Ureteropelvic Junction Obstruction After Open Pyeloplasty in a Large Pediatric Cohort

2008; Lippincott Williams & Wilkins; Volume: 180; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2008.03.086

1527-3792

Luis H. Braga, Armando J. Lorenzo, Darius Bägli, Mélise Keays, Walid A. Farhat, Antoine E. Khoury, João L. Pippi Salle,

Kidney Stones and Urolithiasis Treatments

No AccessJournal of UrologyKidney/Hydronephrosis1 Oct 2008Risk Factors for Recurrent Ureteropelvic Junction Obstruction After Open Pyeloplasty in a Large Pediatric Cohort Luis H.P. Braga, Armando J. Lorenzo, Darius J. Bägli, Melise Keays, Walid A. Farhat, Antoine E. Khoury, and João L. Pippi Salle Luis H.P. BragaLuis H.P. Braga , Armando J. LorenzoArmando J. Lorenzo , Darius J. BägliDarius J. Bägli , Melise KeaysMelise Keays , Walid A. FarhatWalid A. Farhat , Antoine E. KhouryAntoine E. Khoury , and João L. Pippi SalleJoão L. Pippi Salle View All Author Informationhttps://doi.org/10.1016/j.juro.2008.03.086AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Recurrent ureteropelvic junction obstruction after open pyeloplasty is a serious complication for which treatment remains challenging. We identified risk factors for persistent obstruction. Materials and Methods: We retrospectively reviewed the charts of 401 children who underwent open dismembered pyeloplasty between 1997 and 2005. Of these children 21 (5.2%) experienced recurrent ureteropelvic junction obstruction. Age, prenatal diagnosis, hydronephrosis grade, differential renal function, incision location (flank or dorsal lumbotomy), retrograde pyelography and stent placement were analyzed. Univariate and multivariate analyses were performed to identify risk factors for pyeloplasty failure. Results: Median age at surgery was 21 months and median followup was 36 months. Of the 401 patients dorsal lumbotomy was performed in 171 (42.6%) and a flank incision was used in 230 (57.4%). Retrograde pyelography was done in 195 patients (48.6%) and stents were used in 352 (87%). Age, prenatal diagnosis, degree of hydronephrosis, differential renal function and stent placement did not have an impact on pyeloplasty outcome on univariate analysis. Recurrent ureteropelvic junction obstruction developed in 14 of 171 patients who had originally undergone dorsal lumbotomy vs 7 of 230 who had originally undergone a flank incision (8.1% vs 3.1%, p = 0.02) as well as in 17 of 206 who did not undergo initial retrograde pyelography vs 4 of 195 who did (8.3% vs 2.1%, p = 0.005). On multivariate analysis incision type and lack of retrograde pyelography showed significant association with pyeloplasty failure despite adjustment for other risk factors (p <0.05, OR 3.2 and 4.4, respectively). Conclusions: In this series lack of retrograde pyelography and dorsal lumbotomy were independently associated with a higher risk of recurrent ureteropelvic junction obstruction. 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Google Scholar Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byJacobson D, Shannon R, Johnson E, Gong E, Liu D, Flink C, Meyer T, Cheng E and Lindgren B (2019) Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated SeriesJournal of Urology, VOL. 201, NO. 5, (1005-1011), Online publication date: 1-May-2019.Dy G, Hsi R, Holt S, Lendvay T, Gore J and Harper J (2016) National Trends in Secondary Procedures Following Pediatric PyeloplastyJournal of Urology, VOL. 195, NO. 4 Part 2, (1209-1214), Online publication date: 1-Apr-2016.Sturm R, Chandrasekar T, Durbin-Johnson B and Kurzrock E (2018) Urinary Diversion during and after Pediatric Pyeloplasty: A Population Based Analysis of More than 2,000 PatientsJournal of Urology, VOL. 192, NO. 1, (214-220), Online publication date: 1-Jul-2014.Harraz A, Helmy T, Taha D, Shalaby I, Sarhan O, Dawaba M and Hafez A (2013) Changes in Differential Renal Function after Pyeloplasty in ChildrenJournal of Urology, VOL. 190, NO. 4S, (1468-1473), Online publication date: 1-Oct-2013.Ruiz E, Soria R, Ormaechea E, Lino M, Moldes J and de Badiola F (2011) Simplified Open Approach to Surgical Treatment of Ureteropelvic Junction Obstruction in Young Children and InfantsJournal of Urology, VOL. 185, NO. 6S, (2512-2516), Online publication date: 1-Jun-2011.Bayne A, Lee K, Nelson E, Cisek L, Gonzales E and Roth D (2011) The Impact of Surgical Approach and Urinary Diversion on Patient Outcomes in Pediatric PyeloplastyJournal of Urology, VOL. 186, NO. 4S, (1693-1699), Online publication date: 1-Oct-2011.Castagnetti M (2018) Editorial CommentJournal of Urology, VOL. 182, NO. 5, (2432-2433), Online publication date: 1-Nov-2009.Braga L, Lorenzo A, Farhat W, Bägli D, Khoury A and Pippi Salle J (2008) Outcome Analysis and Cost Comparison Between Externalized Pyeloureteral and Standard Stents in 470 Consecutive Open PyeloplastiesJournal of Urology, VOL. 180, NO. 4S, (1693-1699), Online publication date: 1-Oct-2008. Volume 180Issue 4SOctober 2008Page: 1684-1688 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsrecurrenceureteral obstructionkidneycomplicationsurographyMetricsAuthor Information Luis H.P. Braga Equal study contribution. More articles by this author Armando J. Lorenzo Equal study contribution. More articles by this author Darius J. Bägli More articles by this author Melise Keays More articles by this author Walid A. Farhat More articles by this author Antoine E. Khoury More articles by this author João L. Pippi Salle More articles by this author Expand All Advertisement PDF downloadLoading ...