RENAL PELVIS REDUCTION DURING DISMEMBERED PYELOPLASTY FOR CONGENITAL URETERO-PELVIC JUNCTION OBSTRUCTION: IS IT BENEFICIAL?

Mohammad Daboos and Tarek Abdallah Salem*

ABSTRACT

Objectives: To assess the beneficial effect of renal pelvis reduction during dismembered pyeloplasty for congenital ureteropelvic junction (UPJ) obstruction in pediatrics as regard functional and the surgical outcome. Patients and Methods: in a prospective manner, over a two years period, 20 childeren with congenital UPJ obstruction were studied. Pre-operatively, all patients were evaluated by medical history taking, physical examination, routine laboratory investigations, abdominal ultrasonography and diuretic renography. Patients were randomly allocated into 2 treatment groups: group A (10 patients), in which the patients underwent open dismembered pyeloplasty with renal pelvis reduction and group B (10 patients) in which the patients underwent open dismembered pyeloplasty without renal pelvis reduction. Post-operatively, the patients were followed-up regularly after 1, 3 and 6 months. Abdominal ultrasonography was performed at each follow-up visit and diuretic rengraphy scanning only at the end of study. The changes in the renal pelvis diameters and split renal function were assessed and compared between both groups. Results: The study included 20 patients ranged in age from 3 to 36 months (mean: 18.40±6.26). Twelve patients were asymptomatic and diagnosed on routine antenatal ultrasonography evaluation and 8 patients presented by abdominal mass. The mean values of pre-operative parameters including age at operation, renal pelvis diameter, and split renal function were comparable in both groups. There were high significant decrease in the anterior-posterior diameter of renal pelvis and improvement of split renal function when comparing the pre-operative and post-operative values in each group (P˂0.001). However, no significant differences were observed between both groups during all follow-up time points (P˃0.05). Conclusions: The study results showed that, the renal pelvis reduction during open dismembered pyeloplasty has no beneficial effect over pyeloplasty without pelvis reduction technique in pediatric congenital UPJ obstruction, regarding the change in the renal pelvis diameter and split renal function.

Keywords: Dismembered pyeloplasty, Renal pelvis reduction, Split renal function Uretero-pelvic junction obstruction.