Long Term Functional Success After Pyeloplasty for Pelvi-Ureteral Junction Obstruction in Unilateral Poorly Functioning Kidney in Exclusively Adults Population.

ABSTRACT

OBJECTIVES: To assess long-term clinical and functional outcomes postpyeloplasty in unilateral UPJO in poorly functioning kidneys in exclusive adult population. MATERIALS AND METHODS: We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was <30% (by diuretic MAG-3 renography). We further subdivided patients into 2 groups; group (A) SRF ≤20% and group (B) SRF >20% and <30%. Renal function difference was evaluated by the changes in SRF at last follow-up, where 5% change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need of secondary intervention (redo pyeloplasty, nephrectomy, stenting, or endopyelotomy). RESULTS: Among 211 patients. The mean SRF was 20.5 ± 6.6%. After a median follow-up of 67.1 ± 11.8 months, SRF increased significantly to 23.5 ± 7.5 (P<.0001). In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (P <.0001). Functional success was achieved in 88 (95.6%) patients. Whereas, in group (B), SRF increased from 24.9 ± 3.3 to 27.2 ± 6.3 (P <.0001) at last follow-up. Functional success was achieved in 121 (95%) patients. Static SRF in serial follow-up renography had been observed after 12 months of follow-up. CONCLUSION: Pyeloplasty provides high rates of functional success in poorly functioning kidneys. After 12 months follow-up, SRF seems to be static without deterioration.