ESPU Congress 2017 - Abstract book

194

CONGRESS OF THE ESPU

S17-15 (P without presentation)

TREATMENT OF URETEROPELVIC JUNCTION

OBSTRUCTION (UPJO) IN POORLY FUNCTIONING

(DIFFERENTIAL FUNCTION<20%) KIDNEYS: PYELOPLSTY

OR NEPHRECTOMY?

Marco CASTAGNETTI

, Michele GNECH

, Alfredo BERRETTINI

Daniele MODONUTTI

, Dario Guido MINOLI

and Gianantonio MANZONI

1) University Hospital of Padova, Urology Unit, Section for Paediatric Urology, Padova, ITALY - 2) University Hospital

of Padova, Paediatric Urology, Padua, ITALY - 3) Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico,

Pediatric Urology, Milan, ITALY - 4) Univesity Hospital of Padova, Pediatric Urology, Padua, ITALY

PURPOSE

To determine whether pyelopalsty is associated with a higher complication rate than nephrectomy in

poorly functioning kidneys with UPJO, and whether it allows for a functional recovery.

MATERIAL AND METHODS

Retrospective review of 63 patients undergoing surgery for UPJO associate with a differential

renal function (DRF) <20% at 2 centers between 01/2000 and 12/2015. We compared early (within

6 months of surgery) and long term complications between pyeloplasties (n=47) and nephrectomies

(n=16), and the changes in differential renal function after pyeloplasty. Nonparametric tests were

used throughout.

RESULTS

The two groups were comparable in terms of presentation [asymptomatic 31/47 (66%) pyeloplasties

vs. 9/16 (56%) nephrectomies,p=0.5] and rate of preoperative diversions [9/47 (20%) pyeloplas-

ties vs. 4/16 (25%) nephrectomies,p=0.7]. Patients undergoing nephrectomy were older than

those undergoing pyeloplasty [median age 72.8 (range 9-211) months, vs. 15.3 (range 1-240)

months,p=0.01]. Post-operative complications were comparable between groups [2/47 pyelo-

palsties (1 prolonged urinary leakage and 1 urinary tract infection) vs. 1/16 nephrectomies (1 urinary

tract infection) p=1]. The dilatation improved after pyeloplasty in all patients. In 33/47 (70%) pyelo-

plasties, both pre- and post-operative (6-month follow-up) scintigraphy was available. DRF kept

decreasing after surgery in 3/33 (9%), remained unchanged in 21/33 (64%), whereas increased

>5% [median 14% (range 6-28%)] in 9/33 (27%). After a median follow-up of 6.9 (range 1.1-13.7)

years, only 1/47 (2%) patient required a differed nephrectomy, 5.8 years after pyeloplasty, due to

the development of hypertension.

CONCLUSIONS

Despite the limitation that we generally offered nephrectomy to older patients, pyeloplasty does

not seem associated with a significantly higher morbidity that nephrectomy in poorly functioning

kidneys. In almost 25% of our patients, pyeloplasty was followed by an improvement in differential

function of the affected kidney. Need for deferred nephrectomy after pyelopalsty seems exceptional

in decompressed kidneys even though renal function remains poor.