Prompt management of anastomotic leak or acute obstruction after minimally invasive pyeloplasty with percutaneous nephrostomy preserves outcomes

Purpose Urine leak or obstruction in the early postoperative period is a worrisome complication of pyeloplasty. Suboptimal management may risk long-term success. We evaluated percutaneous nephrostomy to manage complications of minimally invasive pyeloplasty.

Materials and Methods We retrospectively analyzed the records of 125 patients who underwent minimally invasive pyeloplasty performed by a single surgeon from May 2004 to May 2013. All complications were catalogued and patients with anastomotic urine leakage or postoperative obstruction were identified. Less than 7 days postoperatively percutaneous nephrostomy was done in each case. Surgical success was defined as resolution of flank pain and/or improved half-time (less than 20 minutes) on diuretic renogram.

Results Early percutaneous nephrostomy placement was required in 12 patients (9.6%) for symptomatic obstruction (6) or anastomotic urine leakage (6) a median of 4.5 days (range 2 to 7) postoperatively. Percutaneous nephrostomies remained in place a median of 9.5 days (range 5 to 42). Median followup was 15 months (range 2 to 80). Mean half-time was 36.4 minutes preoperatively and 11.1 minutes postoperatively. Continued postoperative obstruction (half-time greater than 20 minutes) was documented in 1 (8%) and 13 patients (11.5%) who did and did not require percutaneous nephrostomy placement, respectively. There was no statistical difference in radiological and clinical success rates between the percutaneous nephrostomy group and the 113 patients in whom minimally invasive pyeloplasty was uncomplicated (p = 0.74 and 0.28, respectively).

Conclusions In patients treated with minimally invasive pyeloplasty aggressive management of acute urinary complications with percutaneous nephrostomy placement preserved radiographic and symptomatic outcomes that were comparable to those in patients without complications.