OUTCOME ANALYSIS OF PEDIATRIC PYELOPLASTY AS A FUNCTION OF PATIENT AGE, PRESENTATION AND DIFFERENTIAL RENAL-FUNCTION

Purpose: We retrospectively reviewed a consecutive series of patients who underwent pyeloplasty. In all cases preoperative and postoperative isotope renal scans were performed to assess the surgical outcome wit h particular emphasis on the change in renal function postoperatively. Materials and Methods: The clinical records of 108 consecutive childr en with ureteropelvic junction obstruction were reviewed. Individual r enal function was evaluated and obstruction was confirmed by diuretic assisted (99)mtechnetium diethylenetriaminepentaacetic acid or mercapt oacetyltriglycine renography. A total of 100 pyeloplasties in 98 child ren between 5 days and 16 years old was included. Results were analyze d by groups according to patient age and symptoms at presentation. Res ults: Drainage half-times improved in 98% of patients and only 1 requi red reoperation. Improved renal function greater than 5% was noted in about a third of each age group. Function remained stable in 68% of th e kidneys and decreased in only 1. Of the improved kidneys 77% had imp aired function preoperatively (40% or less of the total contribution). Those presenting with a renal mass had the greatest improvement in fu nction. There was no statistically significant difference in improveme nt in renal function by age group or patient presentation. Regression analysis revealed that preoperative differential renal function was th e only statistically significant predictor of improvement in renal fun ction after pyeloplasty. Conclusions: Pyeloplasty in children is safe and renal functional improvement can be expected in the majority of ki dneys with impaired function at presentation. However, there was no in dication that early pyeloplasty in infants is more likely to result in improved function than in older children.