[43] Post-pyeloplasty follow-up plan, less invasive plan

Objective

To describe a well-structured postoperative pyeloplasty protocol for follow-up, with less cost and minimal possibility of nephron function loss, as pelvi-ureteric junction obstruction (PUJO) is the most common uropathology found in of patients with antenatal hydronephrosis (HN; 30%), with no agreement regarding the ’gold standard’ investigation to use after pyeloplasty for PUJO.

Methods

We retrospectively evaluated 130 paediatric patients with congenital PUJO in the period 2009–2013. Patients with bilateral PUJO or unilateral PUJO in a solitary kidney, associated with a dilated ureter or reflux, and patients with missed follow-up were excluded. We included only those with unilateral PUJO. Open dismembered pyeloplasty with stenting was the technique used in all cases. All patients were investigated postoperatively by multiple ultrasonographies and at least one diuretic renography.

Results

In all, 95 patients with a mean (range) age of 48 (3–180) months were included. After a mean (range) follow-up period of 4 (2–6) years, we assessed outcomes. Overall, 70 patients (73.7%) showed improved HN, 20 (21%) had stable HN, and five (5.3%) had deteriorated and needed re-intervention. Of the improved group, 39 patients (55.7%) improved within the first 6 months and 59 (84.3%) by the end of the first postoperative year, whilst the remaining patients improved in a time range of 2–6 years. None of the improved or stable group had an obstructive washout curve.

Conclusions

As most of the improvement occurs within the first 12 months after pyeloplasty, ultrasonography can be the single modality used for follow-up for the first year post-pyeloplasty for patients with improved HN and those with non-obstructive curves. Only for patients with unimproved HN by the end of the first year post-pyeloplasty, should further investigations be implemented to exclude obstruction.