Outcome of poorly functioning kidneys secondary to PUJO preserved by pyeloplast.

Aims: To study the intermediate term to long-term functional status of kidneys with split renal function(SRF) <15% secondary to PUJO which are preserved by pyeloplasty and to find out whether these kidneys can recover or eventually need nephrectomy.

Methods: 24 patients with SRF<15% and undergoing pyeloplasty with or without prior percutaneous nephrostomy (PCN) were studied. Those with associated VUR, B/L disease and redo pyeloplasties were excluded. Follow up USG and EC scan were done at 3, 9 and 18months and yearly thereafter to document functional status after surgery.

Results: The preoperative SRF ranged from 0.6% to 15% with a mean of 10.61±5.23%. This improved in the postoperative period to a mean of 18.08±7.3%, 18.17±8.63% and 18.42±8.42% at 3months, 9months and 18months follow up respectively, indicating that the maximum improvement occurs early after relief of obstruction and then tends to stabilize or plateau.

Conclusions: We identified no patients who required nephrectomy. Hence, doing pyeloplasty directly for poorly functioning kidneys is much more feasible and PCN should be reserved for acute emergencies like pyonephrosis, grossly palpable kidney or gross hydronephrosis in both kidneys or a solitary kidney.