: Pyeloplasty Can Reverse the Effect of Growth Delay from Ureteropelvic Junction Obstruction in Infants
Eric J. Robinson, BS, Aaron Bayne, MD.
Oregon Health Sciences University, Portland, OR, USA.
BACKGROUNDYoung children with congenital hydronephrosis due to ureteropelvic junction obstruction (UPJO) are often diagnosed prenatally and present without clinical symptoms. Pyeloplasty is a durable and effective intervention for UPJO, and the decision to undergo surgery in young children is typically based on the severity of hydronephrosis or the degree of obstruction and renal function observed on a Lasix nuclear renal scan. Parents often anecdotally note after surgery that children have a significant increase in their appetite and energy. The aim of this study is to determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty.
METHODSWe retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 37 patients underwent pyeloplasty and 72 had no surgical intervention for a two to one case to control match. Patients met criteria if they had both SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op visit and follow up visit 6-12 months later. In non-surgery patients the initial height/weight measurements were taken as close as possible to the median age of surgery in the intervention group and again 6-12 months later.
RESULTSThe surgery and non-surgery groups did not differ in terms of gender (70% vs 72% Male), starting age (325 vs 268 days), starting weight (59th vs 52nd percentile), or time between weight measurements (259 vs 259 days), though the surgery group had significantly less height in the pre-operative period (-11.81 percentile points; 95% CI -23.45 - -0.16) and were more likely to be obstructed on Lasix renal scan (84% w/obstruction vs 26%). In the children who underwent surgery they showed a significant increase in height (18.52 percentile points; 95%CI 10.57 - 26.47) and weight (5.38 percentile points; 95% CI 0.11 - 10.65) from before to after surgery. When comparing the surgery group post-operatively to the non-surgery group over a similar period, the surgery group showed a significant increase in height (mean difference 9.77 percentile points; 95% CI 2.2 - 17.34) and weight (mean difference 21.71 percentile points; 95% CI 12.43 - 30.99) that the non-surgery group did not see.
CONCLUSIONSIn patients with congenital hydronephrosis due to UPJO, patients that underwent pyeloplasty showed a significant increase in weight and height at 6-12 months post-operatively compared to those that deferred operative management. This suggests untreated UPJO might lead to growth delay in infants. 
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