Anderson-Hynes pyeloplasty in horseshoe kidney in children: is it effective without symphysiotomy?

Contemporary reports on surgery for horseshoe kidney (HK) still recommend i sthmotomy and lateropexy to complete an open pyeloplasty. To evaluate wheth er simple Anderson-Hynes pyeloplasty without symphysiotomy is effective for relief of ureteropelvic junction obstruction (UPJO) in HK, we studied the records of ten children, two of whom had bilateral UPJO. Only one child pre sented with calculi; II units were operated upon for UPJO, I needed a parti al nephrectomy. The surgical outcome was evaluated with emphasis on the cha nges in renal drainage and function assessed by ultrasonography and diureti c renal scans. Associated vesicoureteral reflux was observed more often (25 %) than with UPJO in normal kidneys. Obstruction was caused by a crossing l ower-pole vessel in three cases, a high ureteral insertion in two and narro wing of the UPJ 7. Postoperative follow-up (mean 5.5 years) revealed improv ed renal function and good drainage in all cases. Hydronephrosis vanished i n 7, whereas grade 2 hydronephrosis remained in two children with former re fluxive megaureter and grade 3 in one. All children are doing well and have no symptoms due to the persistent isthmus (Rovsing syndrome). It Is conclu ded that simple Anderson-Hynes pyeloplasty via a flank incision is a highly effective and safe procedure for treating UPJO in HK.