Objectives: The primary objective is to analyze the cases, which had redo pyeloplasty and to find out the mode of presentation, reasons for obstruction, indications for redo pyeloplasty and their final outcome.

Methodology: Cases re-operated for obstruction during the period 2000 to 2016 in a single center by the same surgeon, were analyzed. The criteria used to label as post pyeloplasty obstruction (stasis) were (i) Acute presentation with mass and pain immediately after removal of stent. (ii) Sub acute presentation, with mass and pain three weeks after removal of stent. (iii) Recurrence or Late presentation, where there was an initial period of good drainage, but later drainage deteriorated. The investigations redo operative details, per-operative findings and final outcome were analyzed.

Results: There were ten renal units in nine patients. The presentation was acute in three renal units and late in the other seven units. Reversed anastomosis, fibrous entrapment, pseudo-polyp, pseudo-diverticulum, adynamic segment, ureterocele were found to be the structural reasons for obstruction. Functional and morphological outcome after redo pyeloplasty were good in all but one renal unit.

Conclusions: Post pyeloplasty stasis can be due to structural or functional reasons. It is very important to properly identify the cases which need redo pyeloplasty. The main dilemma is in identifying late or recurrent cases.  This is possible only if the patient is kept under systematic and long term follow up.

Keywords: Uretero-pelvic Junction Obstruction, Post Pyeloplasty obstruction, Redo pyeloplasty, Hydrocalyx.

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Sivakumar. K

Department of Pediatric Surgery, SAT Hospital, Government Medical College, Trivandrum Pin: 695011, Kerala University of Health Sciences, India

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