Pyeloplasty for pelviureteric junction obstruction in anomalous kidneys: A long-term follow-up experience at a tertiary care centre.

Introduction: To evaluate the feasibility, safety, and effectiveness of different pyeloplasty procedure approaches for pelvicureteric junction (PUJ) obstruction in kidney anomalies. The presence of difficult, unfamiliar and anomalous anatomy makes pyeloplasty challenging in these conditions.

Patients and methods: We conducted a retrospective review of pyeloplasty in patients with congenital anomalous kidneys at our national tertiary referral centre. Seventeen patients who had pyeloplasty for PUJ obstruction from December 2013 to July 2019 were included.

Results: Seventeen cases had anomalous kidneys consisting of horseshoe kidneys in nine patients, ectopic non-fused kidneys in four patients, ectopic fused kidneys in three patients and duplex kidneys in one patient. The mean follow-up duration was 34 months (4-70 months). The robotic approach was most commonly used in nine patients followed by a laparoscopic and open approach, each in four patients, respectively. Only one patient had an intraoperative complication. One patient required conversion to an open approach. The mean operative duration in open, laparoscopic and robotic approaches was 102 min, 105 min and 140 min, whereas the mean hospital stay was 6.50 days, 3.25 days and 4.22 days, respectively. Post-operative complications occurred in 29.41% of patients with Clavien grade ≥3 complications in one case only (5.88%). Success was 94.12% without any salvage intervention.

Conclusion: Pyeloplasty is a feasible, effective and safe procedure even in complex cases of renal anatomic anomalies with PUJ obstruction. With increasing experience, minimally invasive techniques though technically demanding provide equivalent success rates with better cosmetic outcomes and faster convalescence.