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Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: early sonographic changes that correlate with a loss of differential renal function

 Doo Yong Chung  ;  Chang Hee Hong  ;  Young Jae Im  ;  Yong Seung Lee  ;  Sang Woon Kim  ;  Sang Won Han 
 KOREAN JOURNAL OF UROLOGY, Vol.56(2) : 157-163, 2015 
Journal Title
Issue Date
Adolescent ; Child ; Child, Preschool ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis/diagnostic imaging ; Hydronephrosis/etiology ; Infant ; Kidney/diagnostic imaging ; Kidney/physiopathology* ; Kidney Cortex/pathology ; Kidney Function Tests/methods ; Kidney Pelvis/diagnostic imaging ; Kidney Pelvis/surgery* ; Male ; Postoperative Period ; Prognosis ; Reoperation/adverse effects ; Reoperation/methods ; Retrospective Studies ; Treatment Failure ; Treatment Outcome ; Ultrasonography ; Ureteral Obstruction/complications ; Ureteral Obstruction/pathology ; Ureteral Obstruction/surgery*
Hydronephrosis ; Radioisotope renography ; Treatment failure
PURPOSE: To evaluate changes in differential renal function (DRF), as a functional outcome, in children who underwent redo pyeloplasty for management of failed pyeloplasty and to examine the factors that affect functional outcomes.
MATERIALS AND METHODS: Between January 2002 and November 2010, a total of 18 patients who underwent redo pyeloplasty for persistent ureteropelvic junction obstruction after failed pyeloplasty were enrolled in this study. We assessed perioperative factors and evaluated changes in renal cortical thickness (RCT), renal function, and hydronephrosis by use of serial ultrasound and diuretic renography.
RESULTS: The mean follow-up period was 44.83±28.86 months. After redo pyeloplasty, prevention of further functional deterioration was observed in only 12 of the 18 patients. After dividing the patients according to this observation, we discovered significant differences in both change in DRF (dDRF) and change in RCT (dRCT) (difference between before and after initial pyeloplasty) between the two groups (p<0.001). Additionally, we noted a significant positive correlation between dRCT and dDRF. All patients showed improvements in hydronephrosis grade and relief of symptoms compared with before redo pyeloplasty.
CONCLUSIONS: Redo pyeloplasty should be considered in cases of failed pyeloplasty to preserve renal function and obtain relief from symptoms. If patients show severe deterioration of DRF or a decrease in RCT after initial pyeloplasty, preservation of DRF in these patients after redo pyeloplasty could be difficult. Therefore, redo pyeloplasty should be performed before severe deterioration of DRF or decrease in RCT.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sang Woon(김상운) ORCID logo https://orcid.org/0000-0002-5790-1948
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Im, Young Jae(임영재)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
Hong, Chang Hee(홍창희) ORCID logo https://orcid.org/0000-0002-0946-7702
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