Renal pelvis reduction during dismembered pyeloplasty: Is it necessary?

Objective: To compare treatment results in patients who underwent pyeloplasty with and without pelvic reduction for ureteropelvic junction obstruction (UPJO). Methods: This randomized prospective study involved 40 patients, all diagnosed with unilateral UPJO; 20 each were randomly selected to undergo open dismembered pyeloplasty with pelvic reduction (group A) or pelvis-sparing pyeloplasty (group B). Patients were evaluated with ultrasound and DPTA renography scans 6 months postoperatively. Mean follow-up was 9 months. Results: The mean age in group B was 5.71 +/- 6.36 years; in group A it was 4.81 +/- 6.78 years. There was a decrease in mean anteroposterior renal pelvic diameter (from 49.9 to 26.35 +/- 0.949 mm in A and 50.9 to 30.8 +/- 1.556 mm in B) with improvement of split renal function (from 39 +/- 22.47% to 42.4 +/- 22.13% in A and 34.92 +/- 16.79% to 38.8 +/- 19.66% in B), glomerular filtration rate (from 37.25 +/- 15.33 to 41.7 +/- 19.34 ml/ min in A and 31.3 +/- 18.50 to 38.1 +/- 23.23 ml/min in B) and draining curves on the 6-month scans, but without any significant difference between groups (p > 0.05). Two cases in group A and three in group B needed redo pyeloplasty, but without any significant difference in failure rate. Conclusion: Excision of the pelvis is not necessary in dismembered pyeloplasty procedures. We had similar surgical outcomes for patients with or without pelvis reduction. (C) 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.