PEDIATRIC PYELOPLASTY - OUTCOME ANALYSIS BASED ON PATIENT AGE AND SURGICAL TECHNIQUE

Objectives. To analyze our experience with open pyeloplasty, with spec ific emphasis on procedural outcome on the basis of patient age, surgi cal technique, complication rate, and complication management. Methods . All patients from 1974 to 1994 who underwent pyeloplasty at our inst itution were included in our review. Charts were analyzed for age at p resentation, presenting signs and symptoms, type of surgical reconstru ction, complications and treatment, and final outcome. Results. From 1 974 to 1994, 234 pyeloplasties were performed in 227 patients (108 les s than 1 year old, 119 more than 1 year old). The percentage of childr en less than 1 year old increased throughout: 24% for 1975 to 1980, 37 % for 1981 to 1990, and 69% for 1991 to 1994. Presenting signs and sym ptoms varied according to the age of the child at pyeloplasty. For chi ldren less than 1 year old, these were prenatal ultrasound in 86 (79%) , urinary tract infection (UTI) in 9 (8%), and abdominal mass in 5 (4. 6%). For children more than 1 year old, these were pain in 57 (48%), U TI in 29 (24%), hematuria in 12 (10%), and prenatal ultrasound in 3 (2 .5%). Reconstruction was a dismembered pyeloplasty in all cases. The m ajority of patients in both age groups underwent a nonintubated repair (less than 1 year old, 99 of 114; more than 1 year old, 102 of 120). Postoperative results were evaluated by ultrasound or intravenous urog raphy, with improvement or stable results in 95% of children less than 1 year old and in 96% of children more than 1 year old. Complications included UTI in 18 patients (7.7%), recurrent obstruction in 5 (2.1%) , and persistent leak in 4 (1.7%). The complication rate was not relat ed to age. Conclusions. The nonintubated, dismembered pyeloplasty is a n excellent technique for all age groups and has a low complication ra te. (C) 1997, Elsevier Science Inc. All rights reserved.