Early predictors of surgical failure in paediatric obstructive urinary tract dilatation: a prospective cohort study

Abstract

Introduction: Obstructive urinary tract dilatation (OUTD) is a prevalent condition in paediatric urology that often necessitates surgical intervention. Understanding factors contributing to reoperations is critical for optimizing outcomes. This study aimed to analyze factors associated with reoperations in OUTD. Methods: A prospective cohort study was conducted from 2019 to 2023, including 81 paediatric patients who underwent surgery for OUTD. Patients were categorized into reoperated and non-reoperated groups. Data on diagnostic characteristics, surgical management, and outcomes were collected. The study was approved by the Research Ethics Committee (No. BE-2-34). Statistical analyses was made SPSS, significance level of p<0.05. Main results: The cohort of 81 patients consisted of 51 (63%) patients with ureteropelvic junction obstruction, 20 (24.7%) with ureterovesical junction obstruction, and 10 (12.3%) with aberrant vessel-related obstruction. Over a median follow-up of 16 months (range: 2–72), 17 patients (21%) required reoperations, with a median time to reoperation of 5 months (range: 1–48). Early post-operative complications (56.3% vs. 15.5%, p<0.001) and early UTI during first 3 month after primary operation (52.9% vs. 15.5%, p=0.001) were significantly associated with higher reoperation rates. UTIs occurring later than 3 months postoperatively were not correlated with higher reoperation rates (p>0.05). Conclusion: Reoperation rates in paediatric OUTD highlight the critical role of early postoperative management. Early post-operative complications and UTIs within 3 months after primary surgery are strong predictors of reoperation, emphasizing the need for targeted interventions to reduce these risks. Close follow-up during the first 6 months post-surgery is recommended to improve outcomes.