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Category: Volume 06 Issue 09 September 2018
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Title: Redo-Pyeloplasty: An Analysis

Author: Sivakumar. K

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.105

Abstract

Objectives: The primary objective is to analyze the cases, which had redo pyeloplasty and to find out the mode of presentation, reasons for obstruction, indications for redo pyeloplasty and their final outcome.

Methodology: Cases re-operated for obstruction during the period 2000 to 2016 in a single center by the same surgeon, were analyzed. The criteria used to label as post pyeloplasty obstruction (stasis) were (i) Acute presentation with mass and pain immediately after removal of stent. (ii) Sub acute presentation, with mass and pain three weeks after removal of stent. (iii) Recurrence or Late presentation, where there was an initial period of good drainage, but later drainage deteriorated. The investigations redo operative details, per-operative findings and final outcome were analyzed.

Results: There were ten renal units in nine patients. The presentation was acute in three renal units and late in the other seven units. Reversed anastomosis, fibrous entrapment, pseudo-polyp, pseudo-diverticulum, adynamic segment, ureterocele were found to be the structural reasons for obstruction. Functional and morphological outcome after redo pyeloplasty were good in all but one renal unit.

Conclusions: Post pyeloplasty stasis can be due to structural or functional reasons. It is very important to properly identify the cases which need redo pyeloplasty. The main dilemma is in identifying late or recurrent cases.  This is possible only if the patient is kept under systematic and long term follow up.

Keywords: Uretero-pelvic Junction Obstruction, Post Pyeloplasty obstruction, Redo pyeloplasty, Hydrocalyx.

References

  1. Lim DJ, Walker RD 3rd. Management of the failed pyeloplasty. J Urol 1996; 156:738-40.
  2. Romao RL, Koyle MA, Pippi Salle JL,  Alotay A,  Figueroa VH,  Lorenzo AJ , et al. Failed Pyeloplasty in children: revisiting the unknown. Urology  2013;82:1145-7.
  3. Ben Slama MR, Salomon L,  Hoznck A, Cicco A, Saint F, Alame W,  et al. Extraperitoneal  Laparoscopic repair  of ureteropelvic  junction obstruction: initial experience in 15 cases. Urology  2000;56:45-8.
  4. Tan HJ, Ye Z, Roberts WW,  Wolf JS. Failure after Laparoscopic pyeloplasty: Prevention and management. J Endourol  2011;25:1457-62.
  5. Moscardi PR , Barbosa JA, Andrade HS, Mello MF, Cezarino BN, Oliveira LM, et al. Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children: Safety and Efficacy of the technique. J Urol  2017;197:798-804.
  6. Anderson JC, Hynes W. Retrocaval ureter: A case diagnosed pre-operatively and treated successfully by a plastic    Br J Urol  1949;21:209-14.
  7. Harish J, Joshi K, Roa KLN,  Narasimhan KL, Samujh R, Choudary SK, et al. Pelvi- Ureteric  junction obstruction:  how much is the extent of the upper ureter with defective innervation needing resection. J PedSurg  2003;38:1194-8.
  8. Rohrmann D, Snyder HM 3rd, Duckett  JW Jr, Canning DA, Zderic SA. The operative management of recurrent ureteropelvic  junction obstruction.  J Urol  1997;158: 1257-9.
  9. Rogers A, Hasan T. Management of secondary pelviureteric obstruction. Indian J Urol   2013; 29: 294-302
  10. Miyamoto KK, Mesrobian HG. Long term outcome of kidneys with initial poor drainage or no drainage following pyeloplasty. World  JUrol  1996;14:300-3.
  11. Gupta DK. Pediatric In:  Goel KM, (ed) . Hutchison’s Paediatrics,  2ndedn.  Jaypee Brothers Medical Publishers; 2012.p.246
  12. Dimarco DS, Gettman MT,  McGee SM,  Chow GK,  Leroy AJ,  Slezak J, et al. Long term success of Antegrade endopyelotomy compared with pyeloplasty at a single institution.  J Endourol  2006;20:707-12. 
  13. Braga LH, Lorenzo AJ, Skeldon S,  Dave S,  Bagli DJ,  Khoury AE, et al. Failed  Pyeloplasty in  Children: Comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol 2007;178: 2571-5.
  14. Thomas JC, De Marco RT,  Donohoe JM,  Adams MC,  Pope JC 4th, Brock JW 3rd. Management of failed Pyeloplasty: a contemporary review. J Urol  2005;174: 2363-6.
  15. Psooy K, Pike JG, Leonard MP. Long term follow up of pediatric dismembered pyeloplasty: How long is long enough? J Urol  2003;169:1809.
  16. Braga LH, Lorenzo AJ, Bagli DJ,  Keays M,  Farhat WA,  Khoury AE, et al. Risk factors for recurrent ureteropelvic  junction obstruction after open pyeloplasty in a large pediatric  J Urol 2008;180 4 suppl: 1684-7.
  17. BansalR , Ansari MS, Srivastava A,  Kapoor R. Long term results of pyeloplasty in poorly functioning kidneys in the pediatric age group. J PediatrUrol  2012;8:25-8.
  18. Abdel -Karim AM, Fahmy A, Moussa A, Rashad H, Elbadry M , Badawy H, et al. Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children. J Pediatr Urol  2016;12: 401.e1-e6 doi:10.1016/j.jpurol.2016.06.010 [Epub ahead of print].
  19. Chung DY, Hong CH, Im YJ, Lee YS, Kim SW, Han SW. Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: Early sonographic changes that correlate with a loss of differential renal Korean J Urol 2015; 56: 157-63.

Corresponding Author

Sivakumar. K

Department of Pediatric Surgery, SAT Hospital, Government Medical College, Trivandrum Pin: 695011, Kerala University of Health Sciences, India

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