Calyceal plication with pyeloplasty in the treatment of giant hydronephrosis in children.

The relief of obstruction alone is frequently not sufficient to ensure renal salvage in giant hydronephrosis. We report on our experience with plication of the renal calyces used as an adjunct to dismembered pyeloplasty in patients with giant hydronephrosis. We describe the operative technique and outcomes in ten children after a follow-up period of six months. Ten patients (six girls and four boys) with a mean age of 8.1 years (range 2-14 years) with giant hydronephrosis caused by primary ureteropelvic junction obstruction underwent a dismembered pyeloplasty followed by plication of the dilated renal calyces. The preoperative evaluation included an excretory urography, ultrasonography, 99mTc-DMSA and 99mTc-DTPA scans. The same tests were repeated six months after the operation to evaluate the outcomes. There were no intraoperative or postoperative complications. Excretory urography and ultrasonography performed six months after the operation demonstrated a significant improvement of the morphology of the operated kidneys. The kidneys shrunk in diameter from a mean of 149.5 mm (range 89-224 mm) to 93.6 mm (range 68-121 mm) and the mean diameter of the calyces was reduced from 26.9 mm (range 15-42 mm) to 14.7 mm (range 10-24 mm). Renal 99mTc-DTPA scans showed improved perfusion and renal function after surgery, with the mean elimination rate decreasing from 22.41 min (range 17.84 - 28.22 min) to 11.7 min (range 8.16-13.76 mm). 99mTc-DMSA scans demonstrated no new scars and no deterioration of renal parenchyma after surgery. We believe that plication of the renal calyces is the method of choice to be used as an adjunct to the Anderson-Hynes pyeloplasty in the treatment of paediatric patients with giant hydronephrosis.