Is open pyeloplasty still the first choice of operation for ureteropelvic junction obstruction in children?
Keywords:Ureteropelvic junction obstruction, Open-dismembered pyeloplasty
Objective: To show the results of the treatment of childhood ureteropelvic junction obstruction (UPJO) in Ramathibodi Hospital in order to identify the best current treatment for patients with this condition.
Material and Method: We retrospectively reviewed the medical records of 28 children submitted to open-dismembered pyeloplasty (OP) between May 2006 and Sep 2015. Patient demographic characteristics, pre and postoperative degree of hydronephrosis (HN) based on the measurement of the antero-posterior (AP)
diameter of the renal pelvis, success rate assessed by a change in the degree of HN or renal function and symptom relief, operative time, length of hospital stay, estimated blood loss (EBL), size (length) or site of surgical wound, and complication rate were recorded. A successful outcome was defined according to postoperative radiological improvements in HN by ultrasound, renal function by diuretic renal
scintigraphy and without clinical symptoms.
Result: A total of 31 pyeloplasties in 28 patients were identified. The mean operative time was 115 (+12.12) minutes and the mean EBL was 5.83(+1.91) ml. The mean hospital stay was 5.5 (+0.63) days. Postoperative ultrasound examination showed a diminished grade of HN and decreased AP diameter of the renal pelvis.
The overall success rate was 93.5%.
Conclusion: Our results confirm that OP is within an acceptable range with a short learning curve. We conclude that OP is still the gold standard for the surgical treatment of childhood UPJO in this era. Other aspects, such as surgical costs and patient satisfaction, require further assessment.
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