Nephroureterectomy versus pyeloplasty for giant hydronephrosis in children with upper urinary tract obstruction; perspectives from a tertiary health facility in Southern Nigeria

Philemon E. Okoro, Ngozi O. Ekeke


Background: Unrecognized or neglected cases of obstructed upper urinary tract in children can cause marked dilatation and structural damage to the ureters and kidney/s. In our region, many of such unrecognized obstructions result in giant hydronephrosis with resultant poor outcomes of pyeloplasty. We present our perspective of such giant hydronephrosis and make a case for straight nephroureterectomy rather than pyeloplasty which has been our standard treatment.

Methods: This is a review of cases of congenital upper urinary tract obstruction with giant hydroureteronephrosis seen in children in our practice between March 2008 and February 2017. Case notes of patients who were managed within the period were retrieved to extract relevant data. Data obtained included the biodata, presenting features, dimension of renal pelvis and ureter at imaging and intraoperatively, treatment offered, outcome as at one-year follow-up. Results were subjected to simple statistical analysis.

Results: There were 39 patients and they comprised 22 (56.4%) males and 17 (43.6%) females. Their age range was 3 to 14 years with a mean of 7 years. The most consistent clinical feature was abdominal distension. Five (12.8%) patients had abnormality of renal function preoperatively. The obstruction was unilateral in 30 (76.9%) cases and bilateral in 9 (23.1%) cases giving a total of 48 obstructions. All the patients were operated on. Complications encountered were mostly related to patients in whom we performed pyeloplasty. There were three mortalities related to sepsis and end stage renal disease.

Conclusions: Upper urinary tract obstruction is often recognized late in our practice. Abdominal swelling is a common presenting feature of upper urinary tract obstruction in our practice. It appears that in unilateral cases, nephroureterectomy is a safer and more effective treatment option than pyeloplasty in such late cases with giant hydronephrosis. There is need for a well-designed prospective study to evaluate the option of nephroureterctomy in these cases.


Upper Urinary Tract, Obstruction, Hydronephrosis, Pyeloplasty, Nephroureterectomy

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Toka HR, Toka O, Hariri A, Nguyen HT. Congenital anomalies of kidney and urinary tract. Semin. Nephrol. 2010;30(4):374-86.

Aksu N. Postnatal management of infants with antenatally detected hydronephrosis. Pediatr Nephrol. 2005;20(9):1253-9.

Tullus K. Vesicoureteric reflux in children. Lancet. 2015;385(9965):371-9.

Estrada CR. Prenatal hydronephrosis: early evaluation. Curr Opinion Urol. 2008;18(4):401-3.

Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89(2):149-56.

Mergener K, Weinerth JL, Baillie J. Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist. Am J Gastroenterol. 1997;92(12):2289-91.

Mergener K. Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist. Am J Gastroenterol. 1997;92(12):2289-91.

Duong HP, Piepsz A, Khelif K, Collier F, de Man K, Damry N, et al. Transverse comparisons between ultrasound and radionuclide parameters in children with presumed antenatally detected pelvi-ureteric junction obstruction. Eur J Nucl Med Mol Imaging 2015;42(6):940-6.

Kim SY, Kim MJ, Yoon CS, Lee MS, Han KH, Lee MJ. Comparison of the reliability of two hydronephrosis grading systems: The Society for Foetal Urology grading system versus the Onen grading system. Clin Radiol. 2013;68(9):e484-90.

Menon P, Rao KL, Sodhi KS, Bhattacharya A, Saxena A, Mittal BR. Hydronephrosis: comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure. J Pediatr Urol. 2015;11(2):80.e1-6.

Helmy TE, Harraz A, Sharaf DE, El Demerdash Y, Hafez AT, Gad H, et al. Can renal ultrasonography predict early success after pyeloplasty in children? A prospective study. Urol Int. 2014;93(4):406-10.

Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150:1795-9.

Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR. Laparoscopic pyeloplasty: The first 100 cases. J Urol. 2002;167:1253-6.

Jiang D, Chen Z, Lin H, Xu M, Geng H. Predictive factors of contralateral operation after initial pyeloplasty in children with antenatally detected bilateral hydronephrosis due to ureteropelvic junction obstruction. Urol Int. 2018;100(3):322-6.

Radulović M, Beatović S, Janković M, Šobić-Šaranović D, Artiko V, Ajdinović B. Diuresis renography and ultrasonography in children with antenatally detected hydronephrosis can support diagnoses and suggest related surgery treatment. Hell J Nucl Med. 2017;20:25-36.

Santos DJ, Parekh RS, Piscione TD, Hassouna T, Figueroa V, Gonima P, et al. A new grading system for the management of antenatal hydronephrosis. Clin J Am Soc Nephrol. 2015;10(10):1783-90.

Duncan KA. Antenatal renal pelvic dilatation; the long-term outlook. Clin Radiol. 2007;62(2):134-9.

Miyakita H, Ueno S, Nomura M. Neonatal hydronephrosis detected on routine health check-up. Tokai J Exp Clin Med. 2001;26(3):101-5.

Little SB, Jones RA, Grattan-Smith JD. Evaluation of UPJ obstruction before and after pyeloplasty using MR urography. Pediatr Radiol. 2008;38(1):106-24.

Guys JM, Borella F, Monfort G. Ureteropelvic junction obstructions: Prenatal diagnosis andneonatal surgery in 47 cases. J Ped Surg. 1988;23(2):156-8.

Sharma A, Sodhi KS, Saxena AK, Bhatia A, Menon P, Rao KL, et al. Comparison of intravenous urography and magnetic resonance urography in preoperative evaluation of pelvi-ureteric junction obstruction in children. J Indian Assoc Pediatr Surg. 2016;21(4):169-74.

Rassweiler JJ, Subotic S, Feist-Schwenk M, Sugiono M, Schulze M, Teber D, et al. Minimally invasive treatment of ureteropelvic junction obstruction: Long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty. J Urol. 2007;177:1000-5.

Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG. Laparoscopic pyeloplasty: Evolution of a new gold standard. Urol. 2006;67:932-06.