Long-term renal function post-pyeloplasty: a systematic review

Abstract

Introduction: Ureteropelvic junction obstruction (UPJO) is a significant cause of functional impairment in neonatal kidneys. The gold-standard surgical intervention for UPJO is pyeloplasty, which offers good preservation of kidney function, but long-term renal outcomes and the durability of surgical correction are not fully understood. This systematic review aims to assess the long-term impact of pyeloplasty on renal function, quality-of-life, and complication rates among pediatric patients. Methods: A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library was conducted to retrieve studies reporting long-term outcomes (≥2 years) of pediatric pyeloplasty. Inclusion criteria focused on renal function metrics including differential renal function (DRF), estimated glomerular filtration rate (eGFR), and imaging findings. 9 studies encompassing n = 836 patients met inclusion criteria. Data were synthesized narratively due to significant heterogeneity of methods and reporting. Results: Most studies reported significant improvements in renal function post-pyeloplasty, particularly in cases with low preoperative DRF (< 20%). DRF improvements ranged from 5 to 15%, with preservation or enhancement of renal function observed in up to 89% of cases. Hydronephrosis resolution and increases in renal parenchymal thickness were also reported frequently. Minimally invasive approaches, such as retroperitoneoscopic one-trocar-assisted pyeloplasty, showed comparable efficacy to open techniques. Complications were predominantly minor, including transient urinary infections and stent-related discomfort, with no significant long-term morbidity noted across studies. Conclusion: Pyeloplasty demonstrates durable success in improving or preserving renal function in pediatric patients with UPJO. Early intervention, particularly in cases diagnosed antenatally, yields the best outcomes. While all surgical techniques reviewed were effective, minimally invasive approaches offer reduced operative times and faster recovery. Further research should aim to standardize evaluation protocols and explore the use of novel biomarkers to enhance long-term patient monitoring.