A rare postoperative complication in the treatment of a child with congenital hydronephrosis: A case report

Congenital hydronephrosis is a common developmental anomaly typically diagnosed prenatally. Laparoscopic pyeloplasty is considered the gold standard for the treatment of ureteropelvic junction obstruction due to its high success rate (93–98%) and low incidence of complications. However, hemorrhagic complications remain a concern, particularly in cases of abrupt reductions in intrapelvic pressure, inadequate hemostasis, or coagulopathy, and may be exacerbated by antifibrinolytic therapy. This report describes a clinical case of a male patient with prenatally diagnosed right-sided hydronephrosis, who underwent initial radiologic evaluation at the age of 4. Surgical treatment was recommended but declined by his parents. At age 6, the child was urgently hospitalized with recurrent abdominal pain and vomiting. After stabilization and pain relief, ultrasonography, contrast-enhanced computed tomography, and voiding cystourethrography confirmed the diagnosis of right-sided hydronephrosis and recurrent renal colic. Laparoscopic antevascular pyeloplasty was performed. On postoperative day 2, hemorrhagic urine output was observed through the drain, accompanied by pyelostomy dysfunction. Tranexamic acid, an antifibrinolytic agent, was administered to manage hematuria, resulting in tamponade of the renal pelvis due to blood clot formation. A repeat laparoscopic procedure was required for clot evacuation and placement of additional drains. Subsequent recovery was favorable, with restoration of renal function and urinary drainage, and an uneventful postoperative course. This case underscores the importance of meticulous intraoperative hemostasis and adequate fluid therapy to prevent postoperative complications. The use of antifibrinolytics for gross hematuria following pyeloplasty requires an individualized approach due to the risk of intraluminal thrombosis, renal pelvis tamponade, and potential loss of renal function. In such cases, timely surgical intervention may help preserve renal function.