الفهرس 
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Abstract
Ureteropelvic junction obstruction (UPJO) is a common congenital
urologic anomaly that is commonly complicated by loin pain, urinary infection,
renal deterioration, stone formation, and hypertension. Open Anderson-Hynes
dismembered pyeloplasty remains the gold standard treatment of ureteropelvic
obstruction, although the previous century was witness to many competing
techniques.
Minimally invasive approaches are rapidly becoming the first-line
treatment option. Improved skills of laparoscopic surgeons and use of robotic
assistance have increased the surgical success rates and already made
minimally invasive approaches the first-line therapy at most institutions.
Use of internal stents during pyeloplasty is an urological dogma, which
is thought to facilitate good drainage and be an effective guide for healing
tissues by providing support and alignment. Nonetheless, the use of stents is
not free of complications. As such, the use of stents has been questioned by
many researchers, and in the era of open surgery, stentless pyeloplasty was
reported to be safe in children. The present study aimed to present the success
rate of stentless open pyeloplasty, compared with the stented counterpart.
Between August 2014 to May 2016 the study included 20 pediatric
patients with primary UPJO; 16 cases were males (80%) and 4 cases were
females (20%), 10 cases were right sided (50%) and 10 cases were left sided
(50%) and their mean age was 6.75 (± 4.53). These patients were underwent
Anderson-Hynes pyeloplasty. They are divided randomly into two groups;
group I: 10 cases who were underwent stented pyeloplasty (DJ stent) Group
II: 10 cases who were underwent non- stented pyeloplasty.
Most of the patients were asymptomatic (55%) and were discovered
incidental during examination for another purpose or prenatally, while the
remaining (45%) were complaining of pain; loin pain (40%) & vague
abdominal pain (5%).
All case were investigated by Urine Microscopy culture and sensitivity
with posisitive culture in two cases; those cases postponed until completely
relived from UTI and the new M, C &S became free.
The preoperative ultrasonography revealed different degrees of
hydronephrosis varied from mild to marked hydronephrosis in USS; 6 cases
mild, 7 cases moderate and 7 cases marked hydronephrosis.
Diuretic renogram was done as main method for diagnosis of the
obstruction which revealed good renal function in most of cases (split renal
function > 10%) with definite obstruction in all cases with mean differential
function was 31.523 ± 4.252 in the stented group vs 4.252 ± 6.998 in the
nonstented group.
The mean operative time was longer in the stented group than the nonstented
group 83 minute ±4.83 vs 70.50 minute ±4.73 respectively, but it wasn’t
significantly longer.
The overall postoperative complication was 15 % in the form UTI in one
case (5%) in the stented group and 2 cases (10%) developed urinoma, clot
obstruction in the non-stented group.
Follow up of the cases was done every 2 weeks for 1 months, after 3
months then after 6 months.
The follow up of these case reveled improvement of degree of
hydronephrosis except 4 cases with residual hydrocalycosis but good patency
and funneling in UPJ; 3 in the stented group and 1 in the non-stented group.
And 2 cases showed worsening of the hydronephrosis; one in each group who
were recurrent.
All the cases revealed good renal function preoperatively with
significant improvement in split renal function after operation with no
significant difference between the stented and the non-stented group.
The mean split renal function postoperatively was 49.5 ± 4.24 in the stented
vs 47.30 ± 1.98 in the non-stented.
The overall success rate was 90% in both groups; 1 case remained
obstructed in each group. So there is no significant difference in the success rate
between the two groups.