Pyeloplasty effectiveness in cases of ureteropelvic junction obstruction in children: methodology and assessment parameters

The article presents the analysis of published data (Scopus, Web of Science, PubMed/MedLine, The Cochrane Library, and eLIBRARY databases) devoted to the study of existing criteria for assessment of pyeloplasty effectiveness. Published sources most often refer to the dynamics of reduction of the renal collecting system (RCS) and postoperative renal functional status as the assessment criteria. However, there are no consistent values, which could be employed as assessment criteria indicating success as soon as they are registered. The tools used to estimate RCS reduction are not standardized in terms of research techniques, projection of RCS dilatation measurement, and the locations between which renal and pelvic anatomic structures are measured. A variety of approaches to measuring the anteroposterior renal pelvis dimension in children with hydronephrosis tends to blur the analysis of actual pyeloplasty results. This review of published sources demonstrates the lack of agreement as regards the criteria for assessment of pyeloplasty effectiveness. There is a pressing need for appropriate steps to harmonize ultrasonography methods, to standardize the anatomic landmarks for measurement, and to define the criteria to be used to assess the effectiveness of pyeloplasty.

Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study.Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty.Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation.Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.