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Short-term outcomes of pyeloplasty vs. nephrectomy in adult patients with ureteropelvic junction obstruction and differential renal function ≤15.

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  • معلومة اضافية
    • المصدر:
      Publisher: Medical Journals Sweden AB Country of Publication: Sweden NLM ID: 101587186 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2168-1813 (Electronic) Linking ISSN: 21681805 NLM ISO Abbreviation: Scand J Urol Subsets: MEDLINE
    • بيانات النشر:
      Publication: 2023-: Uppsala, Sweden : Medical Journals Sweden AB
      Original Publication: Colchester, Esssex : Informa Healthcare
    • الموضوع:
      Laparoscopy* ; Ureteral Obstruction*/surgery; Adult ; Humans ; Kidney/physiology ; Kidney/surgery ; Kidney Pelvis/surgery ; Nephrectomy/adverse effects ; Retrospective Studies ; Treatment Outcome ; Urologic Surgical Procedures/adverse effects
    • نبذة مختصرة :
      Objectives: To compare symptom resolution and short-term renal function after pyeloplasty or nephrectomy in adults with ureteropelvic junction obstruction (UPJO) in poorly functioning renal units (PFRU).
      Methods: Retrospective analysis of adult patients with UPJO and differential renal function (DRF) ≤ 15% who underwent laparoscopic pyeloplasty or nephrectomy. Primary endpoints included symptom resolution and estimated glomerular filtration rate (eGFR) at 12 months. Surgical complications were compared between groups. A secondary analysis was performed comparing baseline and postoperative DRF to evaluate the PFRU recovery potential after pyeloplasty.
      Results: Sixty-three patients were included; 19 underwent pyeloplasty and 44 underwent nephrectomy. The mean age of the cohort was 39.5 ± 13.8 years. Nephrectomy was associated with significantly higher intra-operative blood loss ( p  = 0.02). Operative time and length of hospital stay were not significantly different between groups. There were three complications in the nephrectomy group, and none in the pyeloplasty group ( p  = 0.34). Symptom resolution rates were equivalent between groups (73% vs. 76%; p  = 0.78). The eGFR variation was not statistically different after pyeloplasty or nephrectomy (+6.2 vs. +0.1 mL/min/1.73m 2 , respectively; p  = 0.18). Patients undergoing pyeloplasty had no significant change in the mean DRF (baseline 9.5 vs. 10%; p  = 0.99).
      Conclusion: Pyeloplasty can be considered for selected patients with UPJO in PFRU as an organ-sparing alternative to nephrectomy. Although there was no significant gain in mean DRF, pyeloplasty prevented further functional loss and relieved symptoms in most cases in the short-term with at least the same complication rates of nephrectomy.
    • Contributed Indexing:
      Keywords: Pyeloplasty; differential renal function; nephrectomy; split renal function; ureteropelvic junction obstruction
    • الموضوع:
      Date Created: 20210202 Date Completed: 20211025 Latest Revision: 20220424
    • الموضوع:
      20250114
    • الرقم المعرف:
      10.1080/21681805.2021.1879929
    • الرقم المعرف:
      33525931