Society For Pediatric Urology

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Does low preoperative renal function predict failure in robotic pyeloplasty?
Diana K. Bowen, MD, Ravindra Sahadev, MD, Christopher J. Long, MD, Aseem Shukla, MD, Arun K. Srinivasan, MD.
The Children's Hospital of Chicago, Philadelphia, PA, USA.

Does low preoperative renal function predict failure in robotic pyeloplasty?
Recently it has been suggested that preoperative renal function (PRF) may be a determinant of post-operative success in robot-assisted pyeloplasty (RP) in children. Our study aim was to determine the threshold of PRF for success in RP.
We performed a retrospective review of all RPs performed at our institution by 7 surgeons over a period of 10 years. Patients without documented PRF on MAG3 or MRU, with a solitary kidney or bilateral obstruction, or those without at least one post-operative ultrasound were excluded. The primary outcome was failure defined by recurrence of symptoms or worsening hydronephrosis with need for re-intervention. Patients were stratified into groups by PRF: 0-10% (n=6), 11-20% (n=10), 21-30%(n=19), 4= 31-40% (n=43), and > 40%(n=102). Statistical analysis was carried out with 2-sample t-test, logistic regression and Fisher’s exact test when appropriate.
From 2008 to 2017, 180 patients who had preoperative functional data available underwent RP, including 10 redo pyeloplasties. Mean age was 6.4 ± 5.9 years old with a mean follow-up time of 18.8 ± 16.2 months. Overall there were 10 failures with no statistically significant difference in age, gender, side, surgeon, and overall PRF with the rest of the cohort (PRF 40% vs. 38.9%; p=0.80). Between PRF groups, there was no significant difference in failure rate (p=0.7). A subanalysis of those with both pre- and post-operative function revealed that lower functioning groups on average had a more positive gain than higher functioning groups after RP.
Low preoperative renal function alone does not portend failure and RP can be considered for select patients even with < 10% function. Long term followup is paramount in this population.

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