Uretero-pelvic junction obstruction (UPJO) is the most common cause of obstructive uropathy in children. However, the timing of surgical intervention is debatable and the effect of delayed surgical intervention is also not well-understood. For example, COVID-19 pandemic has led to institutional delays and surgical shutdowns in all medical fields worldwide. Therefore, we aimed to identify the effect of delay in surgical intervention on renal function in cases of of unilateral UPJO and factors that may affect it.

In a retrospective study, database of children who underwent pyeloplasty for unilateral UPJO in a tertiary center from January 2016 to October 2020 was reviewed. Patients who had a delay in pyeloplasty for more than 3 months from the time of diagnosis were identified. Patients for whom 3 renograms were performed at the time of surgical decision, immediately before surgery and within one year postoperatively were included in the study. Deterioration was defined as 5% or more decline in the split renal function (SRF) between 2 consecutive renograms. Patients were then categorized into 2 groups; group of preserved renal function (group 1) and group of deteriorated renal function (group 2) based on the difference in preoperative renograms. Both groups were compared regarding the preoperative and postoperative Antero-posterior diameter (APD), grading of hydronephrosis (HN), percent of change of HN, change in SRF and duration of delay in months.

A total 46 children were included in the study; 30 patients had preserved renal function (group 1), while 16 patients had significant deterioration of SRF (group 2). Group 2 showed higher percent increase of APD and more delay in the surgical intervention on univariate analysis, p value = 0.016 and 0.001, respectively (Table 1). On multivariate analysis these factors showed significant difference between both groups. However, other factors did not show any significant difference between the two groups. None of the patients who had surgery within 6 months showed functional deterioration.

In our study, children who underwent pyeloplasty for unilateral UPJO, were divided into 2 groups; group 1 had preserved renal function, while group 2 had significant deterioration of SRF. The group of deteriorated SRF significantly showed higher percent increase of APD and more delay in the surgical intervention. However, other factors did not show any significant difference between both groups. On the other hand, none of the patients who had delayed surgery within 6 months showed functional deterioration.

Delaying of surgical intervention for less than 6 months may not lead to functional deterioration. Moreover, worsening of HN might precede functional deterioration.

Continence 2S2 (2022) 100433
DOI: 10.1016/j.cont.2022.100433