Short-term outcomes of pyeloplasty vs. nephrectomy in adult patients with ureteropelvic junction obstruction and differential renal function ≤15.

Autor: Freitas PFS; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Barbosa JABA; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Cho DH; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Boffa ABM; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Andrade HS; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Arap MA; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio Libanês, São Paulo, Brazil., Duarte RJ; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Nahas WC; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Srougi M; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil., Srougi V; Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Moriah, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Scandinavian journal of urology [Scand J Urol] 2021 Jun; Vol. 55 (3), pp. 192-196. Date of Electronic Publication: 2021 Feb 01.
DOI: 10.1080/21681805.2021.1879929
Abstrakt: Objectives: To compare symptom resolution and short-term renal function after pyeloplasty or nephrectomy in adults with ureteropelvic junction obstruction (UPJO) in poorly functioning renal units (PFRU).
Methods: Retrospective analysis of adult patients with UPJO and differential renal function (DRF) ≤ 15% who underwent laparoscopic pyeloplasty or nephrectomy. Primary endpoints included symptom resolution and estimated glomerular filtration rate (eGFR) at 12 months. Surgical complications were compared between groups. A secondary analysis was performed comparing baseline and postoperative DRF to evaluate the PFRU recovery potential after pyeloplasty.
Results: Sixty-three patients were included; 19 underwent pyeloplasty and 44 underwent nephrectomy. The mean age of the cohort was 39.5 ± 13.8 years. Nephrectomy was associated with significantly higher intra-operative blood loss ( p  = 0.02). Operative time and length of hospital stay were not significantly different between groups. There were three complications in the nephrectomy group, and none in the pyeloplasty group ( p  = 0.34). Symptom resolution rates were equivalent between groups (73% vs. 76%; p  = 0.78). The eGFR variation was not statistically different after pyeloplasty or nephrectomy (+6.2 vs. +0.1 mL/min/1.73m 2 , respectively; p  = 0.18). Patients undergoing pyeloplasty had no significant change in the mean DRF (baseline 9.5 vs. 10%; p  = 0.99).
Conclusion: Pyeloplasty can be considered for selected patients with UPJO in PFRU as an organ-sparing alternative to nephrectomy. Although there was no significant gain in mean DRF, pyeloplasty prevented further functional loss and relieved symptoms in most cases in the short-term with at least the same complication rates of nephrectomy.
Databáze: MEDLINE
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