Safety and efficacy of pyeloplasty in children aged less than 1 year: experience from a tertiary care hospital of North India

Abstract Introduction Ureteropelvic junction obstruction (UPJO) is the predominant etiology of hydronephrosis in neonates and can lead to chronic renal impairment if not treated. The timing of pyeloplasty in infants under the age of one is controversial secondary to issues of anesthetic safety, technical complexity, and spontaneous resolution. Materials and methods This prospective cohort study assessed the safety and effectiveness of pyeloplasty in 62 infants less than 12 months old. Inclusion criteria were obstructed hydronephrosis or compromised drainage, and exclusion criteria included bilateral UPJO requiring synchronous intervention, solitary kidney, or concomitant anomalies. Open or laparoscopic Anderson–Hynes pyeloplasty was done, with follow-up standardized to include ultrasonography and diuretic renography. Results Mean age at surgery was 6.2 ± 2.8 months. Postoperative complications in 11.3% of infants were primarily minor, with only one requiring an intervention of DJ stent repositioning. Differential renal function also significantly improved from 32.5 ± 6.8% preoperatively to 39.1 ± 7.2% by 12 months ( p < 0.001). Success of the operation was seen in 95.2%, with Kaplan–Meier survival at one year and three years at 98% and 95%, respectively, being intervention-free. Conclusions Early pyeloplasty is safe, effective, and with significant functional recovery, especially in infants operated on before the age of 6 months.