Interventional Radiology Procedures after Pediatric Pyeloplasty and Ureteral Reimplantation in Patients with Postoperative Obstruction

Brent W. Snow, M. Chad Wallis, G. Peter Feola, John W. Rampton, Teisha Shiozaki

Division of Pediatric Urology, University of Utah School of Medicine, Salt Lake City, USA.
Primary Children’s Medical Center, Salt Lake City, USA.

DOI: 10.4236/oju.2014.46015                

Abstract

Introduction: Obstructive complication after pyeloplasty or ureteral reimplant surgery is a rare though worrisome problem in pediatric urology. These are often complex patients with complicated post-operative courses that at times require interventional radiology procedures. The current literature is lacking in guiding principles to manage these complications. In this study we have reviewed these difficult to manage patients at our children’s hospital over the past 15 years. Methods: A list of patients who underwent interventional radiology procedures to place nephrostomy tubes or internal double-J ureteral stents was compared a list of patients undergoing pyeloplasty or reimplant procedures. These lists were cross-referenced to a list of patients undergoing cystoscopic removal of double-J stents. This small patient group does not represent all complications but those with radiology intervention. Results: At our institution, during the years 1998-2011 we performed 458 pyeloplasties and 3003 open ureteral reimplant procedures. 14 (0.4%) met all of the inclusion criteria. The long term outcome of these problems showed 11 of these patients went on to stability or improvement with either percutaneous drainage or JJ stent placement alone, and three of the reimplant patients ultimately required redo surgery. Of our pyeloplasty patients only three required percutaneous nephrostomy tube, and one went on to JJ stent placement (0.66% of pyeloplasties). No patients in the pyeloplasty group needed surgical revision. Of patients how had undergone ureteral reimplantation, with or without tapering, seven of them underwent interventional radiology procedures (0.23% of reimplant patients). Conclusion: Pediatric urology patients with persistent obstruction after pyeloplasties and ureteral reimplantation surgery with or without tapering who needed interventional radiology rescue procedure resolved or stabilized in 11 of 14 patients. Surgical revision was performed in only 3 of our 14 patients after months of conservative trial after interventional radiologic procedures.

Keywords

Interventional Radiology, Pediatrics, Ureteral Reimplantation, Pyeloplasty, Postoperative Obstruction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Uppot, R.N. (2009) Emergent Nephrostomy Tube Placement for Acute Urinary Obstruction. Techniques in Vascular and Interventional Radiology, 12, 154-161. http://dx.doi.org/10.1053/j.tvir.2009.08.010
[2]	Rosman, B.M., Passerotti, C.C., Kohn, D., Recabal, P., Retik, A.B. and Nguyen, H.T. (2012) Hydronephrosis Following Ureteral Reimplantation: When Is It Concerning? Journal of Pediatric Urology, 8, 481-487. http://dx.doi.org/10.1016/j.jpurol.2011.10.017
[3]	Charbonneau, S.G., Tackett, L.D., Gray, E.H., Caesar, R.E. and Caldamone, A.A. (2005) Is Long-Term Sonographic Followup Necessary after Uncomplicated Ureteral Reimplantation in Children? The Journal of Urology, 174, 1429-1431; Discussion 31; Author Reply 31-2. http://dx.doi.org/10.1097/01.ju.0000173128.73742.bc
[4]	Falkensammer, M.L., Gobet, R., Stauffer, U.G. and Weber, D.M. (2008) To Cohen and Forget? Evaluation of Postoperative Imaging Studies after Transtrigonal Ureteric Reimplantation for Vesicoureteric Reflux in Children. Urologia Internationalis, 81, 218-221. http://dx.doi.org/10.1159/000144065
[5]	Barrieras, D., Lapointe, S., Reddy, P.P., Williot, P., McLorie, G.A., Bigli, D., et al. (2000) Are Postoperative Studies Justified after Extravescial Ureteral Reimplantation? The Journal of Urology, 164, 1064-1066. http://dx.doi.org/10.1016/S0022-5347(05)67251-5
[6]	Bomalaski, M.D., Ritchey, M.L. and Bloom, D.A. (1997) What Imaging Studies Are Necessary to Determine Outcome after Ureteroneocystostomy? The Journal of Urology, 158, 1226-1228. http://dx.doi.org/10.1016/S0022-5347(01)64436-7
[7]	Braga, L.H., Lorenzo, A.J., Skeldon, S., Dave, S., Bagli, D.J., Khoury, A.E., et al. (2007) Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy versus Redo Pyeloplasty. The Journal of Urology, 178, 2571-2575; Discussion 5. http://dx.doi.org/10.1016/j.juro.2007.08.050
[8]	Thomas, J.C., DeMarco, R.T., Donohoe, J.M., Adams, M.C., Pope IV, J.C. and Brock 3rd., J.W. (2005) Management of the Failed Pyeloplasty: A Contemporary Review. The Journal of Urology, 174, 2363-2366. http://dx.doi.org/10.1097/01.ju.0000180420.11915.31