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Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction.

Publication ,  Journal Article
Crivelli, JJ; Johnson, BA; Steinberg, RL; Gahan, JC; Antonelli, JA; Morey, AF; Pearle, MS; Cadeddu, JA
Published in: Int Braz J Urol
2021

PURPOSE: We aimed to assess failure rates of salvage interventions and changes in split kidney function (SKF) following failed primary repair of ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS: A retrospective review of adult patients at an academic medical center who underwent salvage intervention following primary treatment for UPJO was performed. Symptomatic failure was defined as significant flank pain. Radiographic failure was defined as no improvement in drainage or a decrease in SKF by ≥7%. Overall failure, the primary outcome, was defined as symptomatic failure, radiographic failure, or both. RESULTS: Between 2008-2017, 34 patients (median age 38 years, 50% men) met study criteria. UPJO management was primary pyeloplasty/secondary endopyelotomy for 21/34 (62%), primary pyeloplasty/secondary pyeloplasty for 6/34 (18%), and primary endopyelotomy/secondary pyeloplasty for 7/34 (21%). Median follow-up was 3.3 years following secondary intervention. Patients undergoing primary pyeloplasty/secondary endopyelotomy had significantly higher overall failure than those undergoing primary pyeloplasty/secondary pyeloplasty (16/21 [76%] vs. 1/6 [17%], p=0.015). Among patients undergoing secondary endopyelotomy, presence of a stricture on retrograde pyelogram, stricture length, and SKF were not associated with symptomatic, radiographic, or overall failure. Serial renography was performed for 28/34 (82%) patients and 2/28 (7%) had a significant decline in SKF. CONCLUSIONS: Following failed primary pyeloplasty, secondary endopyelotomy had a greater overall failure rate than secondary pyeloplasty. No radiographic features assessed were associated with secondary endopyelotomy failure. Secondary intervention overall failure rates were higher than reported in the literature. Unique to this study, serial renography demonstrated that significant functional loss was overall infrequent.

Duke Scholars

Published In

Int Braz J Urol

DOI

EISSN

1677-6119

Publication Date

2021

Volume

47

Issue

6

Start / End Page

1209 / 1218

Location

Brazil

Related Subject Headings

  • Urology & Nephrology
  • Urologic Surgical Procedures
  • Ureteral Obstruction
  • Retrospective Studies
  • Male
  • Laparoscopy
  • Kidney Pelvis
  • Humans
  • Female
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Crivelli, J. J., Johnson, B. A., Steinberg, R. L., Gahan, J. C., Antonelli, J. A., Morey, A. F., … Cadeddu, J. A. (2021). Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction. Int Braz J Urol, 47(6), 1209–1218. https://doi.org/10.1590/S1677-5538.IBJU.2021.0303
Crivelli, Joseph J., Brett A. Johnson, Ryan L. Steinberg, Jeffrey C. Gahan, Jodi A. Antonelli, Allen F. Morey, Margaret S. Pearle, and Jeffrey A. Cadeddu. “Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction.Int Braz J Urol 47, no. 6 (2021): 1209–18. https://doi.org/10.1590/S1677-5538.IBJU.2021.0303.
Crivelli JJ, Johnson BA, Steinberg RL, Gahan JC, Antonelli JA, Morey AF, et al. Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction. Int Braz J Urol. 2021;47(6):1209–18.
Crivelli, Joseph J., et al. “Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction.Int Braz J Urol, vol. 47, no. 6, 2021, pp. 1209–18. Pubmed, doi:10.1590/S1677-5538.IBJU.2021.0303.
Crivelli JJ, Johnson BA, Steinberg RL, Gahan JC, Antonelli JA, Morey AF, Pearle MS, Cadeddu JA. Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction. Int Braz J Urol. 2021;47(6):1209–1218.

Published In

Int Braz J Urol

DOI

EISSN

1677-6119

Publication Date

2021

Volume

47

Issue

6

Start / End Page

1209 / 1218

Location

Brazil

Related Subject Headings

  • Urology & Nephrology
  • Urologic Surgical Procedures
  • Ureteral Obstruction
  • Retrospective Studies
  • Male
  • Laparoscopy
  • Kidney Pelvis
  • Humans
  • Female
  • Adult