Pyeloplasty safe, effective in kidneys with poor function also: Study
USA: Pyeloplasty is equally safe and effective in poorly functional kidney and in kidney with better renal function, finds a recent study in the Journal of Pediatric Urology. According to the study, preoperative differential renal function did not predict success rate of pyeloplasty. Patients having DRF ≤10% did not have higher incidence of complications or failure rate.
In short, DRF alone should not effect the management options available for ureteropelvic junction obstruction (UPJO) patients, wrote the authors.
Indications for UPJO treatment include urinary tract infections, symptomatic obstruction, worsening differential renal function (DRF) and/or presence of an obstructive pattern on functional renal scan. Arun K. Srinivasan, Children's Hospital of Philadelphia, Philadelphia, PA, USA, and colleagues hypothesized that low preoperative DRF is not an independent predictor of pyeloplasty failure.
To test the hypothesis, the researchers performed a retrospective chart review for identifying all patients undergoing pyeloplasty for UPJO between 2008 and 2019. It included 364 patients who met inclusion criteria of having at least one preoperative functional scan and a minimum of one renal ultrasound post-operatively.
Patients were divided into three groups based on DRF for analysis: Group 1- 0-10% (n=1), Group 2 - >10-≤20% (n=24), Group 3 - >20% (n=332). The researchers then compared Baseline, intraoperative and postoperative characteristics, including success and complications.
Key findings of the study include:
- Mean procedure time was longest for the ≤10% function group (237.9 vs 206.4 vs 189.1).
- There was no difference in 30-day post-operative complications, overall success rate or the need for additional procedures among the three groups.
- For patients in Group 1, we noted variation in the post-procedure DRF with a range of −2.8 to +47% change.
- In this group, none of patients with low DRF underwent nephrectomy.
- Multivariate logistic regression did not identify renal function as a predictor of operative success OR 1.00.
"The results of the present study suggest that low DRF alone is not associated with worse outcomes and shows no difference in the failure rate. The incidence and type of complications were not increased for the lower functioning groups," wrote the authors.