Management of the failed pyeloplasty

Purpose: We present our experience with repeat surgery for persistent ureteropelvic junction obstruction. Materials and Methods: We retrospectively reviewed the records of patients who underwent pyeloplasty for ureteropelvic junction obstruction between 1984 and 1994, focusing on those who underwent repeat surgery for persistent ureteropelvic junction obstruction after initial pyeloplasty. Results: During the 10-year period 127 pyeloplasties were done by a single surgeon (R. D. W.). Three cases of persistent ureteropelvic junction obstruction occurred in this primary pyeloplasty series (success rate 97.6%). During the same period 9 other patients were referred to us from elsewhere for persistent ureteropelvic junction obstruction after initial pyeloplasty (total 12 patients). Ten patients underwent repeat pyeloplasty with a postoperative stent in place. Two patients needed nephrectomy at the initial repeat procedure and 1 of the 10 repeat pyeloplasty patients ultimately underwent nephrectomy. Six patients who had recurrent ureteropelvic junction obstruction were younger than 6 months at the time of the original pyeloplasty. Excessive urinary drainage was noted in 2 of our 3 cases of failed pyeloplasty. Thus, in 9 patients satisfactory resolution of obstruction was achieved by repeat pyeloplasty (salvage rate 75%). Conclusions: Persistent ureteropelvic junction obstruction is an uncommon complication after pyeloplasty. Infants who undergo pyeloplasty may be more prone to persistent obstruction after pyeloplasty. Prolonged urinary drainage seems to be a harbinger of persistent ureteropelvic junction obstruction. Careful repeat pyeloplasty with attention to preservation of the blood supply and meticulous watertight anastomosis led to satisfactory resolution of ureteropelvic junction obstruction in 75% of the cases.