Surgical management of ureteropelvic junction obstruction in pediatric horseshoe kidney: outcomes and renal function recovery

Abstract Background This study aims to describe our institutional experience in managing pediatric patients with PUJO associated with horseshoe kidney, focusing on clinical presentation, diagnostic evaluation, surgical management, and outcomes. By presenting these findings, we seek to contribute practical data that may guide diagnosis and treatment strategies for this rare but significant anomaly in children. Methods This retrospective study included 10 children (< 18 years) with PUJO in HSK managed at Sher-i-Kashmir Institute of Medical Sciences between January 2015 and December 2023. Diagnostic evaluation included ultrasonography, CT-IVP, VCUG, and renal scintigraphy (DMSA/MAG3). Surgical interventions included open transperitoneal or retroperitoneal pyeloplasty with or without vascular hitch procedures. Patients were followed for a minimum of six months postoperatively to assess symptom resolution and renal function. Results The cohort comprised 6 males and 4 females, with a mean age of 8.5 ± 4.2 years. Common symptoms were recurrent UTIs (40%) and flank pain (30%). Imaging confirmed HSK and varying grades of hydronephrosis. Aberrant or crossing vessels were found in 70% of cases and corrected intraoperatively. Open transperitoneal pyeloplasty was the most frequently employed approach (8/10). Postoperative recovery was uneventful in most patients, with mean hospital stay of 4.5 ± 1.3 days. Follow-up showed improved drainage and renal function in all patients. Complications included proteinuria and hypertension in one patient each. Renal scarring was observed in 2 patients preoperatively. Conclusion Open surgical management of PUJO in HSK is effective and safe in pediatric patients. Early diagnosis and appropriate surgical correction lead to favorable outcomes, including symptom relief and preservation of renal function. Larger prospective studies are warranted to guide long-term management strategies.