Pyeloplasty outcomes in children with complex anatomy: an observational series of reconstruction in concurrent ureterovesical obstruction, duplex, malrotated or ectopic moieties and horseshoe kidneys.

PURPOSE: Ureteropelvic junction obstruction (UPJO) with concurrent renal anomalies can introduce surgical complexity, increasing the risk of surgical complications and redo pyeloplasty. We sought to determine whether anatomic complexity is associated with higher morbidity. METHODS: We retrospectively identified 59 children with UPJO and a concurrent complex congenital renal anomaly (CCRA) at our institution between 2008 and 2023, and matched them with 177 non-complex controls. CCRAs included ectopic, duplex, malrotated and horseshoe kidneys and concurrent UPJ + UVJ obstruction. Data were abstracted regarding patient demographics, perioperative variables, and pre- and post-operative imaging findings. The primary outcomes were emergency department visits and surgical complications, including recurrent obstruction. RESULTS: Baseline characteristics did not differ between CCRA patients and controls. CCRA patients had a longer median procedure time (159 vs. 135 min., p = 0.01). No differences were found in primary outcomes, including reoperation (control: 6.8% vs. CCRA: 5.1%, p = 0.77) and emergency department visit rate (15.8% vs. 27.1%, p = 0.05). Hydronephrosis severity based on percent improvement on ultrasound was similar between groups. CONCLUSION: Despite an increased technical burden, a concurrent renal anomaly does not increase the rate of redo pyeloplasty compared with the classically accepted failure rate. Pyeloplasty in patients with CCRAs is thus feasible, and careful attention is required during follow-up imaging.