Functional Outcomes of Open Pyeloplasty in 100 Infants: A Retrospective Observational Study

A BSTRACT Introduction: Open pyeloplasty remains widely practiced in infants. This study evaluates the anatomical and functional outcomes of open pyeloplasty in infants over 10 years. Materials and Methods: This retrospective observational study of infants who underwent open pyeloplasty for pelvi-ureteric junction obstruction between 2015 and 2024. Preoperative assessment comprised clinical evaluation, ultrasonography, and diuretic renography. Indications for surgery included worsening hydronephrosis, obstructed drainage, and declining renal function. All patients underwent Anderson–Hynes pyeloplasty. Trans-anastomotic double-J stents were used selectively in cases with a floppy pelvis or associated anomalies. Functional outcome was categorized as improved (>5% increase), stable, or deteriorated (>5% decrease), or split renal function. Results: Hundred open pyeloplasties were performed in 97 infants. The mean age was 5.6 months. Three were bilateral procedures. Most infants (82%) were asymptomatic. Gross hydronephrosis (antero-posterior diameter [APD]: >20 mm) was present in 78 renal units (mean APD: 24.3 mm). EC renography showed obstructed drainage in 86%. DJ stents were used in 45 procedures. At 6-month follow-up, hydronephrosis improved in all renal units (mean APD: 13.4 mm). Drainage improved in 99%; one patient required redo pyeloplasty. Functional outcomes showed improvement in 43%, stable in 56% and deterioration in 1%. Infants with poorer renal function and <3 months of age demonstrated greater functional recovery ( P < 0.05), while severity of hydronephrosis (>2 cm APD) did not ( P > 0.05). Multivariate logistic regression analysis showed that children with preoperative SRF <20% had significantly higher chances of postoperative functional gain compared with those having SRF >20%. Age at surgery and preoperative APD were not independently associated with functional improvement. Early complications occurred in two (2%), and one late recurrence (1%) required reoperation. Conclusion: Open pyeloplasty in infants is safe and associated with excellent anatomical and functional outcomes with minimal morbidity. Poor preoperative renal function was associated with greater postoperative functional recovery.