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URETEROCALICOSTOMY: A BAILOUT PACKAGE FOR KIDNEY PRESERVATION IN SECONDARY PELVIURETERIC JUNCTION OBSTRUCTION
Liaqat Ali*, Mishal Nazim, Muhammad Shahzad, Faiza Hayat, Nasir Orakzai and Qudratullah Wazir
To study the successful outcome of Guillotine method of lower pole Ureterocalicostomy for the treatment of secondary ureteropelvic junction obstruction (PUJO). Methods: It is a descriptive study, conducted in Department of Urology at Institute of Kidney Diseases Hayatabad Peshawar Pakistan from June 2012 till March 2020. Total numbers of 22 patients with secondary PUJO were included in the study. We excluded the adult patients with renal function less than 20% and pediatric patients with renal function less than 10% on DTPA renal scan. After thorough radiological and nuclear imaging, the patients were subjected to lower pole Ureterocalicostomy. All the Preoperative, intra-operative and postoperative data was recorded on structured proforma and was analyzed on SPSS. Results: The Mean age of the patient was 28.5 years ± 9.7 years. The mean Pre operative Glomerular filtration rate (GFR) was 27.3 ± 5.9 ml/minute The mean cortical thickness on Ultrasound was 8.18±1.5. The mean pre operative split renal function on renal scan was 29.95%±5.525. Although Marginal improvement can be observed in postoperative renal scan at 6 month duration by 31 % but not significant (p= 0.140). Lower pole Ureterocalicostomy was found successful in relieving the obstruction and saving the kidney in 20 (90.9%) patients. The multivariate analysis showed poor cortical thickness less than 7mm and spit renal function below 20 % (p 0.001) as independent factors of failure in 2 patients. Conclusion: Ureterocalicostomy proves to be a bail-out package for the preservation of kidney in cases of complicated secondary Ureteropelvic Junction Obstruction.[Full Text Article]