Is open pyeloplasty still justified?

Abstract

Objective: To determine the success rate, complications and morbidity from open pyeloplasty.

Patients and methods: The study included 63 patients with confirmed pelvi-ureteric junction (PUJ) obstruction who underwent 66 pyeloplasties. Their records were analysed retrospectively for age, clinical presentation, serum creatinine level, presence of infection, surgical technique, and pre- and post-operative isotopic renography. The mean (range) follow-up was 15.5 (3-60) months.

Results: Pain was the most common presenting symptom; most pyeloplasties were dismembered and 77% of the procedures were performed by urological trainees. Retrograde pyelography did not alter the management in any patient. The complications were persisting PUJ obstruction in four, urinary leakage in two, transient vesico-ureteric obstruction in two and meatal stenosis in one. There were no complications in non-intubated pyeloplasties. Pain was successfully relieved in 98% of patients, renal function improved or remained stable in 92% and deteriorated in 7.7%. One patient underwent a revision pyeloplasty and another required nephrectomy. A younger patient, absence of urinary tract infection and absence of palpable mass were favourable factors.

Conclusion: Pyeloplasty is the most effective and permanent treatment for PUJ obstruction. Newer endoscopic procedures currently used must be carefully assessed against this 'gold standard' before becoming widespread.