Fifteen-year single-center experience with pediatric pyeloplasty: surgical outcomes and reoperation rates from 2010 to 2025

Abdelhameed A. Elkassaby; Mohamed S. Mostafa

doi:10.18203/2349-2902.isj20251895

Authors

Abdelhameed A. Elkassaby Department of Paediatric Surgery, Royal Aberdeen Children’s Hospital, Aberdeen, United Kingdom; Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt
Mohamed S. Mostafa Department of Paediatric Surgery, Royal Aberdeen Children’s Hospital, Aberdeen, United Kingdom; Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20251895

Keywords:

Ureteropelvic junction obstruction, Pediatric pyeloplasty, Laparoscopic surgery, Reoperation, Surgical outcomes

Abstract

Background: Ureteropelvic junction obstruction (UPJO) is a leading cause of pediatric hydronephrosis, often requiring surgical correction to prevent progressive renal damage. Despite innovations in minimally invasive techniques, long-term data on surgical durability and reoperation rates remain limited.

Methods: The study was conducted in the Royal Aberdeen Children’s Hospital. We conducted a retrospective review of 66 consecutive pediatric pyeloplasties performed at a tertiary center from January 2010 to December 2025. We collected data on patient demographics, surgical approach (open vs. laparoscopic), operative metrics, complications, and reoperation incidence. Outcomes were analyzed using χ² tests for categorical variables and ANOVA for continuous variables, with logistic regression for predictors of reoperation.

Results: Of the 66 patients (mean age 5.2±3.6 years; 66.7% male), the proportion receiving laparoscopic repair rose from 0% to 88% over the study period. Overall reoperation rate was 6.1% (n=4), with the highest risk in infants <6 months (12.0%) and those with severe calyceal dilatation (9.5%). Mean operative time decreased from 145±30 min in 2010–2014 to 92±18 min in 2020–2025. No major (Clavien–Dindo ≥III) complications occurred.

Conclusions: Pediatric pyeloplasty at our institution demonstrates excellent long-term success. The shift to laparoscopic technique has improved perioperative efficiency without compromising outcomes. Targeted strategies are warranted for high-risk subgroups, and ongoing surveillance of functional and patient-centered metrics will enrich decision-making.

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References

Lebowitz RL. Vesicoureteral Reflux and Renal Scarring in Children. Radiology. 1992;184(1):149-58.

Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6(3):212-31. DOI: https://doi.org/10.1016/j.jpurol.2010.02.205

Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol. 1990;144(2 Pt 2):584-7. DOI: https://doi.org/10.1016/S0022-5347(17)39528-9

Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, et al. Laparoscopic pyeloplasty in infants: step-by-step technique and outcome analysis. Urology. 2002;59(5):770-3.

Anderson JC, Hynes W. Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol. 1949;21(3):209-14. DOI: https://doi.org/10.1111/j.1464-410X.1949.tb10773.x

Cascini V, Lauriti G, Di Renzo D, Miscia ME, Lisi G. Ureteropelvic junction obstruction in infants: open or minimally invasive surgery? A systematic review and meta-analysis. Front Pediatr. 2022;10:1052440. DOI: https://doi.org/10.3389/fped.2022.1052440

Andolfi C, Lombardo AM, Aizen J, Recabal X, Walker JP, Barashi NS, et al. Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for ureteropelvic junction obstruction in infants: multi-institutional comparison of outcomes and learning curves. World J Urol. 2022;40(4):1049-56. DOI: https://doi.org/10.1007/s00345-022-03929-0

Autorino R, Zargar H, Mariano MB, Sanchez-Salas R, Sotelo RJ, Chlosta PL et al. Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European-American Multi-institutional Analysis. Eur Urol. 2014;65(3):494-507.

Cundy TP, Harling L, Hughes-Hallett A, Mayer EK, Najmaldin AS, Athanasiou T, et al. Meta-analysis of robot-assisted vs conventional laparoscopic and open pyeloplasty in children. BJU Int. 2014;114(4):582-94. DOI: https://doi.org/10.1111/bju.12683

Passerotti CC, Nguyen HT, Lais A, Dunning P, Harrell B, Estrada C, Lee R, Retik AB, Peters CA. Robot-assisted laparoscopic ileal bladder augmentation: defining techniques and potential pitfalls. J Endourol. 2008;22(2):355-60. DOI: https://doi.org/10.1089/end.2007.0238

Reed F, Recabal X, Echeverría P, Braga LH, Cherian A, Gatti JM, et al. Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study. World J Urol. 2023;41(6):1675-79. DOI: https://doi.org/10.1007/s00345-023-04359-2

Braga LH, Lorenzo AJ, McLorie GA. Laparoscopic pyeloplasty in paediatric patients: a single-center experience. J Urol. 2008;180(1):279-83.

Alqarni NH, Alyami FA, Alshayie MA, Abduldaem AM, Sultan M, Almaiman SS, et al. Minimally invasive versus open pyeloplasty in the pediatric population: comparative retrospective study in a tertiary centre. Urol Ann. 2024;16(3):215-17. DOI: https://doi.org/10.4103/ua.ua_101_23

Uçan AB, Yaslı G, Şahin M, Okur Ö, Şencan A. Long-term outcomes of pyeloplasty in children with poorly functioning kidneys. J Urol Surg. 2023;10(4):301-6. DOI: https://doi.org/10.4274/jus.galenos.2023.2023-8-6

Abdulfattah S, Aghababian A, Saxena S, Eftekharzadeh S, Mitchell A, Ai E, et al. Outcomes of pediatric pyeloplasty in a contemporary cohort. J Pediatr Urol. 2024;20(6):1174-8. DOI: https://doi.org/10.1016/j.jpurol.2024.07.019

Peters CA, Schlussel RN, Retik AB. Pediatric laparoscopic dismembered pyeloplasty. J Urol. 1995;153(6):1962-5. DOI: https://doi.org/10.1016/S0022-5347(01)67378-6

Ansari MS, Mandhani A, Singh P, Srivastava A, Kumar A, Kapoor R, et al. Laparoscopic pyeloplasty in children: long-term outcome. Int J Urol. 2008;15(10):881-4. DOI: https://doi.org/10.1111/j.1442-2042.2008.02139.x

Chandrasekharam VVS, Babu R. A systematic review and meta-analysis of conventional laparoscopic versus robot-assisted laparoscopic pyeloplasty in infants. J Pediatr Urol. 2021;17(4):502-10. DOI: https://doi.org/10.1016/j.jpurol.2021.03.009

Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Predictors of outcomes after pediatric pyeloplasty. J Urol. 2002;168(6):2560-3.

Passerotti CC, Nguyen HT, Lais A, Dunning P, Harrell B, Estrada C, et al. Ureteropelvic junction obstruction: results of robot-assisted laparoscopic pyeloplasty. J Urol. 2009;182(3):1537-41.