Management of ureteropelvic junction obstruction associated with congenital upper urinary tract anomalies in children: Single-center experience

Abstract

Purpose We report our experience in the management of ureteropelvic junction  obstruction in children with congenital upper urinary tract anomalies.
Materials and methods A retrospective review was performed for all children with primary ureteropelvic junction obstruction associated with upper urinary tract anomalies between 1999 and 2011 at our hospital. Medical records were reviewed for patient age, sex, type of urinary tract anomalies, affected side, indication of surgery, and operative details. Clinical and radiological outcomes were assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at final follow-up.
Results There were 12 children (10 boys and two girls) with mean age of 5.3 years (range 1–13 years). Anomalies included ectopic pelvic kidney in six patients,  crossed fused ectopia in two, a horseshoe kidney in two, and duplex renal units in two. The left kidney was affected in seven and the right kidney in five children. All patients were managed by open dismembered pyeloplasty. No significant perioperative complications were encountered in the study group. The mean follow-up was 30 months (range 15–45 months). Overall success rate was 84%. Relief of obstruction was evident in 10 patients as documented by intravenous urography or diuretic renography. Secondary nephrectomy was necessitated in two patients; one had severely impaired ipsilateral renal function and the other had recurrent pyelonephritis without radiological improvement.
Conclusion Despite the anomalous renal anatomy and the challenging surgical  exposure, dismembered pyeloplasty in children with upper urinary tract anomalies has a high success rate with excellent functional results.

Keywords: crossed ectopic, horseshoe kidney, obstruction, pyeloplasty, ureter