Long-term followup of pediatric dismembered pyeloplasty: how long is long enough?

PURPOSE

We determined followup for pediatric patients after pyeloplasty based on the risk of late complications and the likelihood of return if discharged early from followup.

MATERIALS AND METHODS

We retrospectively reviewed the charts of all patients who underwent dismembered pyeloplasty at a single center between 1986 and 1996. Data regarding recurrent ureteropelvic junction obstruction and symptoms suggesting possibly recurrent obstruction were assessed.

RESULTS

During the select period 123 pyeloplasties were performed. A total of 77 renal units were followed greater than 5 years. At 1 year postoperatively diuretic renograms showed normal drainage in 87% of the cases and prolonged or incomplete drainage in 13%. Obstruction recurred 8 years postoperatively in only 1 renal unit (0.8% overall, 1.3% of those followed greater than 5 years). Symptoms suggestive of recurrent obstruction developed in 18% of the patients but represented true recurrence in only 1. If one were to consider early followup discharge for these patients, the probability of repeat referral due to such symptoms was significantly higher in year 1 than in year 3. Most symptoms were initially assessed with ultrasound.

CONCLUSIONS

Recurrent ureteropelvic junction obstruction is unlikely after unobstructed postoperative diuretic renogram and does not warrant long term followup. Ideal followup would extend to 2 years, covering the period when an initial symptom of recurrence is most likely to present and enabling baseline unobstructed renal ultrasound to be performed.