Giant hydronephrosis in children: resection or preservation, what is the best approach?

The purpose of this study is to assess functional and morphologic recovery in children after dismembered pyeloplasty for GH caused by UPJO of children. From Jan 2005 to Dec 2010, 38 pediatric patients with GH who underwent dismembered pyeloplasty performed by a single surgeon were retrospectively analyzed. Patient follow-up was at least 3 years. The outcomes of different types of UPJO were compared. DRF and RPT assessed more than 3 years postoperatively were compared according to ages and time. Improvement of DRF and RPT was also compared. The relationship between the improvement in DRF in the first six months and renal function assessed in 3-year was also analyzed. The results showed that the renal function of functional obstruction was significantly lower than other groups (p<0.0001). GH patients who underwent pyeloplasty before 36 months of age (n = 12) experienced more improvement in DRF compared with GH patients who underwent surgery after 36 months of age (n = 21) (p<0.0001). DRF measured in the first six postoperative months was significantly higher than other groups (n = 12) (p<0.0001). There is a positive positive correlation between DRF in the first six months and renal function assessed in 3-y (r =0.8193). In conclusion, it is worthwhile to preserve the kidney in children with GH. Functional obstruction should be independent from UPJO and surgical treatment is inadvisable. The rate of improvement in DRF in the first six months is a good indicator to outcome. Published by www.inter-use.com. Available online Dec. 5, 2015, Vol.4 Issue 1, Page 8-14.