Surgical treatment of children with recurrent hydronephrosis

Introduction. Hydronephrosis is a common form of kidney pathology in children. Despite the early diagnosis and optimistic results of surgical treatment of the obstruction of the pyelourethral segment, which reach 98% in children, a group of patients with recurrent hydronephrosis is forming, which requires the development of optimal tactics for its surgical treatment.

Aim: to determine the effectiveness of various methods of surgical treatment of recurrent hydronephrosis in children.

Materials and methods. Seventy one patient with recurrent hydronephrosis was observed in the Department of pediatric urology-andrology. The age of the patients ranged from 6 months to 17 years. In 36 patients of the main group, the treatment of recurrent hydronephrosis was carried out according to the author’s algorithm. In 35 patients of the comparison group, treatment was carried out using traditional methods before the introduction of the algorithm into practice.

Results. Recurrence of hydronephrosis in children was diagnosed within 1 to 28 months after initial surgical treatment for obstruction of the pyelourethral segment. The cause of recurrent hydronephrosis in 47 patients was stricture of the pelvic ureteral segment, an aberrant vessel was detected in 5 patients, and in 9 patients a pronounced bend of the ureter in the pyelourethral segment was determined due to compression by the lower pole of the kidney. A combination of several causes of recurrent hydronephrosis was noted in 10 patients. In patients with recurrent hydronephrosis, whose treatment was carried out according to the author’s algorithm, a less pronounced scarring process and a shorter length of ureteral stricture were revealed, as well as a shorter period of hospital stay than in patients treated without taking into account the developed algorithm. In patients treated according to the author’s algorithm, a positive result was achieved in 93%, and in patients of the comparison group — in 88% of cases.

Conclusion. To increase the effectiveness of surgical treatment of children with recurrent hydronephrosis, an integrated approach is needed, choosing the optimal tactics of surgical treatment.

Contribution:
Sharkov S.M., Lobach A.Yu. — concept and design of the study;
Lobach A.Yu., Surov R.V., Lazishvili M.N., Morozov K.D., Kovachich A.S., Kondratieva T.A. — collection and processing of the material;
Lobach A.Yu., Sharkov S.M. — writing the text;
Shmyrov O.S., Kulaev A.V. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: May 17, 2024
Accepted: June 11, 2024
Published: July 12, 2024

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

2. Minnillo B.J., Cruz J.A., Sayao R.H., Passerotti C.C., Houck C.S., Meier P.M., et al. Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults. J. Urol. 2011; 185(4): 1455–60. https://doi.org/10.1016/j.juro.2010.11.056

3. Riachy E., Cost N.G., Defoor W.R., Reddy P.P., Minevich E.A., Noh P.H. Pediatric standard and robot-assisted laparoscopic pyeloplasty: a comparative single institution study. J. Urol. 2013; 189(1): 283–7. https://doi.org/10.1016/j.juro.2012.09.008

4. Abdel-Karim A.M., Fahmy A., Moussa A., Rashad H., Elbadry M., Badawy H., et al. Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children. J. Pediatr. Urol. 2016; 12(6): 401.e1–6. https://doi.org/10.1016/j.jpurol.2016.06.010

5. Corbett H.J., Mullassery D. Outcomes of endopyelotomy for pelviureteric junction obstruction in the paediatric population: A systematic review. J. Pediatr. Urol. 2015; 11(6): 328–36. https://doi.org/10.1016/j.jpurol.2015.08.014

6. Chung D.Y., Hong C.H., Im Y.J., Lee Y.S., Kim S.W., Han S.W. Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: early sonographic changes that correlate with a loss of differential renal function. Korean J. Urol. 2015; 56(2): 157–63. https://doi.org/10.4111/kju.2015.56.2.157

7. Tan B.J., Smith A.D. Ureteropelvic junction obstruction repair: when, how, what? Curr. Opin. Urol. 2004; 14(2): 55–9. https://doi.org/10.1097/00042307-200403000-00002

8. Eden C.G. Minimally invasive treatment of ureteropelvic junction obstruction: a critical analysis of results. Eur. Urol. 2007; 52(4): 983–9. https://doi.org/10.1016/j.eururo.2007.06.047

9. Parente A., Angulo J.M., Romero R.M., Rivas S., Burgos L., Tardáguila A. Management of ureteropelvic junction obstruction with high-pressure balloon dilatation: long-term outcome in 50 children under 18 months of age. Urology. 2013; 82(5): 1138–43. https://doi.org/10.1016/j.urology.2013.04.072

10. Osther P.J., Geertsen U., Nielsen H.V. Ureteropelvic junction obstruction and ureteral strictures treated by simple high-pressure balloon dilation. J. Endourol. 1998; 12(5): 429–31. https://doi.org/10.1089/end.1998.12.429

11. Al-Hazmi H., Peycelon M., Carricaburu E., Manzoni G., Neel K.F., Ali L., et al. Redo laparoscopic pyeloplasty in infants and children: feasible and effective. Front. Pediatr. 2020; 8: 546741. https://doi.org/10.3389/fped.2020.546741

12. Li J., Yang Y., Li Z., Fan S., Wang X., Yang Z., et al. Redo laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction: Propensity score matched analyses of a high-volume center. Front. Pediatr. 2022; 10: 997196. https://doi.org/10.3389/fped.2022.997196

13. Braga L.H., Lorenzo A.J., Skeldon S., Dave S., Bagli D.J., Khoury A.E., et al. Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J. Urol. 2007; 178(6): 2571–5. https://doi.org/10.1016/j.juro.2007.08.050

14. Basiri A., Behjati S., Zand S., Moghaddam S.M. Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction after failed open surgery. J. Endourol. 2007; 21(9): 1045–51. https://doi.org/10.1089/end.2006.0414

15. Helmy T.E., Sarhan O.M., Hafez A.T., Elsherbiny M.T., Dawaba M.E., Ghali A.M. Surgical management of failed pyeloplasty in children: single-center experience. J. Pediatr. Urol. 2009; 5(2): 87–9. https://doi.org/10.1016/j.jpurol.2008.09.001

16. Thomas J.C., DeMarco R.T., Donohoe J.M., Adams M.C., Pope J.C. 4th, Brock J.W. 3rd. Management of the failed pyeloplasty: a contemporary review. J. Urol. 2005; 174(6): 2363–6. https://doi.org/10.1097/01.ju.0000180420.11915.31

17. Lindgren B.W., Hagerty J., Meyer T., Cheng E.Y. Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective treatment option. J. Urol. 2012; 188(3): 932–7. https://doi.org/10.1016/j.juro.2012.04.118

18. Piaggio L.A., Noh P.H., González R. Reoperative laparoscopic pyeloplasty in children: comparison with open surgery. J. Urol. 2007; 177(5): 1878–82. https://doi.org/10.1016/j.juro.2007.01.053

19. Casale P., Grady R.W., Joyner B.D., Zeltser I.S., Figueroa T.E., Mitchell M.E. Comparison of dismembered and nondismembered laparoscopic pyeloplasty in the pediatric patient. J. Endourol. 2004; 18(9): 875–8. https://doi.org/10.1089/end.2004.18.875

20. Romao R.L., Koyle M.A., Pippi Salle J.L., Alotay A., Figueroa V.H., Lorenzo A.J., et al. Failed pyeloplasty in children: revisiting the unknown. Urology. 2013; 82(5): 1145–7. https://doi.org/10.1016/j.urology.2013.06.049

21. Ceyhan E., Dogan H.S., Tekgul S. Our experience on management of failed pediatric pyeloplasty. Pediatr. Surg. Int. 2020; 36(8): 971–6. https://doi.org/10.1007/s00383-020-04699-9

22. Duan H., Zhu W., Zhong W., Li X., Zeng G. Balloon dilation for failed pyeloplasty in children? Int. Braz. J. Urol. 2019; 45(3): 617–20. https://doi.org/10.1590/S1677-5538.IBJU.2018.0407

23. Parente A., Angulo J.M., Burgos L., Romero R.M., Rivas S., Ortiz R. Percutaneous endopyelotomy over high pressure balloon for recurrent ureteropelvic junction obstruction in children. J. Urol. 2015; 194(1): 184–9. https://doi.org/10.1016/j.juro.2015.01.074

24. Radford A.R., Thomas D.F., Subramaniam R. Ureterocalicostomy in children: 12 years experience in a single centre. BJU Int. 2011; 108(3): 434–8. https://doi.org/10.1111/j.1464-410X.2010.09925.x

25. Adamic B.L., Lombardo A., Andolfi C., Hatcher D., Gundeti M.S. Pediatric robotic-assisted laparoscopic ureterocalycostomy: salient tips and technical modifications for optimal repair. BJUI Compass. 2020; 2(1): 53–7. https://doi.org/10.1002/bco2.53

26. Reggio E., Richstone L., Okeke Z., Kavoussi L.R. Laparoscopic ureteroplasty using on-lay appendix graft. Urology. 2009; 73(4): 928.e7–10. https://doi.org/10.1016/j.urology.2008.06.034

27. Shen X., Xv M., Liu G., Xu G., Wu Y., Lin H., et al. Ureteral replacement with appendix in a pediatric group: a report of two cases and review of the literature. Eur. J. Pediatr. Surg. 2012; 22(4): 329–31. https://doi.org/10.1055/s-0032-1313335

28. Cao H., Zhou H., Yang F., Ma L., Zhou X., Tao T., et al. Laparoscopic appendiceal interposition pyeloplasty for long ureteric strictures in children. J. Pediatr. Urol. 2018; 14(6): 551.e1–5. https://doi.org/10.1016/j.jpurol.2018.06.017

29. Dagash H., Sen S., Chacko J., Karl S., Ghosh D., Parag P., et al. The appendix as ureteral substitute: a report of 10 cases. J. Pediatr. Urol. 2008; 4(1): 14–9. https://doi.org/10.1016/j.jpurol.2007.08.004

30. Liu D., Zhou H., Hao X., Cao H., Ma L., Zhou X., et al. Laparoscopic Yang-Monti ureteral reconstruction in children. Urology. 2018; 118: 177–82. https://doi.org/10.1016/j.urology.2018.04.034

31. Sharkov S.M., Shmyrov O.S., Lobach A.Yu., Kulaev A.V., Surov R.V., Lazishvili M.N., et al. Formation of pyeloenteroureteroanastamosis in a child with recurrent hydronephrosis caused by long-term ureteral stenosis. Voprosy prakticheskoy pediatrii. 2022; 17(6): 121–4. https://doi.org/10.20953/1817-7646-2022-6-121-124 (in Russian)