Abstract

Background: Management of poorly functioning kidneys with ureteropelvic junction obstruction (UPJO) is controversial, with some recommending direct nephrectomy and others direct pyeloplasty, and others temporary diversion.
Aim of the study: to determine the outcome and whether pyeloplasty allows for functional recovery in poorly functioning kidneys in the pediatric age group.
Patient & method: A prospective review of 25 patients with unilateral UPJO who underwent open Anderson-Hynes pyeloplasty (AHP) with a split renal function (SRF) 10-20% at Baghdad Medical City for the period between December 2019 to September 2022 was conducted, the changes in the SRF measured by MAG-3 study after 1-year were compared.
Results: our study included 25 patients divided into two groups below (52%) and above (48%) 1-year-old with preoperative SRF 10%-20% of the affected side, Success was defined based on either improvement in symptoms, improvement in drainage on postoperative diuretic renography, and/or improvement or stability in SRF on the renal scan done 12 months postoperatively.
Deterioration of SRF by more than 5% was deemed a Failure. An increase in SRF of more than 5% was deemed an improvement. (17)
Mean preoperative SRF was 15.4±2.8% in all cases, which increased postoperatively in the success group from 15.5±2.9% to 23.7±4.7%, and this improvement was highly significant, while in two cases with failure with SRF from 13.5±2.1% to 5.5±2.1%.
The success rate was 92%, whereas a secondary nephrectomy was necessary for two (8.0%).
Conclusion: Poorly functioning renal units with SRF 10% - 20%, can show functional improvement and recoverability, so in these renal units, we can’t rush to do a nephrectomy instead, we can proceed to pyeloplasty.