Surgical correction of ureteropelvic junction obstruction in children. An eight-year single-centre experience and the impact of antenatal detection

Background: Ureteropelvic junction obstruction (UPJO) is the leading cause of congenital hydronephrosis. We evaluated the presentation, operative management, and outcomes of pyeloplasty for UPJO in children, and compared antenatally with postnatally detected disease. Methods: We retrospectively reviewed 88 children who underwent pyeloplasty at a single tertiary centre over eight years (2016–2023). Diagnosis combined ultrasonography with diuretic MAG3 renography. All children remained under institutional surveillance, median 71 months from surgery to census (range 24 to 119). A favourable outcome was a ≥ 2-grade SFU reduction with no clinical or radiological evidence of persistent obstruction. Results: Boys predominated (59/88, 67.0%). Median age at surgery was 82 months, and 31 children (35.2%) were detected antenatally. Most were symptomatic (78/88, 88.6%), and 68 (77.3%) had SFU grade 4. Anderson–Hynes dismembered pyeloplasty was performed in 82 (93.2%), predominantly open (86/88, 97.7%), with no postoperative complications. All 88 kidneys regressed by ≥ 2 SFU grades, a favourable outcome in 100%. Antenatally detected children were operated earlier (median 14 vs. 121 months, p < 0.001) and were more often asymptomatic (22.6% vs. 5.3%, p = 0.030). Pain was confined to children older than five years. Conclusions: Open Anderson–Hynes pyeloplasty achieved hydronephrosis regression in every child without postoperative complications. Antenatal detection permitted earlier and more often asymptomatic intervention, but only a minority of operated children were detected before birth.