Stentless pyeloplasty for paediatric ureteropelvic junction obstruction: a 15-year experience at Red Cross War Memorial Children’s Hospital

Abstract

Purpose: This study aimed to evaluate the outcome of stentless dismembered pyeloplasty for congenital ureteropelvic junction obstruction (UPJO).

Materials and methods: We retrospectively reviewed the data of paediatric patients who underwent dismembered pyeloplasty due to congenital UPJO between January 2008 and July 2022. Patients’ demographics, indications for surgery, follow-up data, and complications were recorded in a data extraction sheet. The success rate was defined by not needing intervention or reoperation postoperatively. Data analysis was done using Stata/SE 15.0 and p = 0.05 was used as a cut-off point for statistical significance.

Results: A total of 91 patients underwent pyeloplasty during the study period. The final analysis included 50 patients, excluding those who underwent stented pyeloplasty (17), aged above 13 years (1), and patients with missing data (23). The median age of study participants was four months (interquartile range [IQR]: 1–110). Most patients (90%) underwent open dismembered pyeloplasty, and 10% underwent laparoscopic-assisted dismembered pyeloplasty. The success rate (not needing surgical intervention postoperatively) was 90%. There was a statistically significant improvement between the pre- and postoperative anteroposterior (AP) pelvic diameter mean (p = 0.0000), renal output efficiency at 40 minutes (p = 0.0000), and normalised residual activity (NORA) on a mercaptoacetyltriglycine (MAG3) renogram (p = 0.0001). However, the difference in differential renal function pre- and postoperatively was not statistically significant (p = 0.0558). The most common complications were fever (30%), followed by abdominal pain (26%), and urinary tract infections (22%).

Conclusion: Stentless pyeloplasty is a safe and reliable technique for children. In resource-limited countries, such as sub-Saharan Africa, stentless pyeloplasty could be adopted as a standard technique because it is not inferior to stented pyeloplasty and is associated with low morbidity while being cost-effective.