1. RISK FACTORS FOR RECURRENT URETEROPELVIC JUNCTION OBSTRUCTION AFTER
PYELOPLASTY
S. Pérez-Bertólez, O. Martín- Solé, J. Arboleda, F. Vicario, A. Martín-Lluis, L. García-Aparicio
Pediatric Surgery Department. Hospital S. Joan de Déu.Division of Pediatric Urology.
. Spain.Universitat de Barcelona
Aim of the Study:
Persistent or recurrent ureteropelvic junction obstruction after a pyeloplasty is an uncommon
complication which management remains challenging. The aim of our study is to identify the risk
factors associated with recurrent ureteropelvic junction obstruction.
Methods:
Retrospective chart review of patients who underwent pyeloplasty from 1997 to 2017 at our
institution was performed. The study focused on patients with recurrence of ureteropelvic
junction obstruction after the initial surgery. Demographic data, clinical, surgical and radiological
variables were assessed. A multivariate logistic regression analysis was performed in order to
identify risk factors for surgical complications and need for redo-surgery.
Main results:
340 pyeloplasties were performed and 10 children underwent redo-pyeloplasty for secondary
obstruction in this period. The independent risk factors for redo-surgery in a multivariate logistic
regression model were: urinary leak (OR=6.92, 95%CI:1.16-41.35) and bigger anteroposterior
diameter of the renal pelvis (OR=1.05, 95%CI:1.003-1.101). Sex, age, weigh, side, surgical
approach (open and laparoscopy) and differential renal function did not have an impact on the
need of redo-surgery.
Older age (in months, OR=1.01, 95%CI:1.002-1.02), higher preoperative differential renal
function (OR=1.04, 95%CI:1.01-1.08) and the use of stent across the ureterovesical junction
(OR=3.32, 95%CI:1.26-8.76) are independent risk factors for urinary leak.
Conclusions:
There is a trend toward recurrent ureteropelvic junction obstruction in patients with urinary leak
after pyeloplasty and those with higher preoperative anteroposterior diameter of the renal pelvis.
Older patients, higher preoperative differential renal function and stent across the ureterovesical
junction are independent risk factors for urinary leak.
