Redo Pyeloplasty in Adults: If a Childhood Repair Recurs

The success of Anderson–Hynes (dismembered) pyeloplasty is reported at roughly 90–95% and above in the literature; failure is roughly 3–5%, and most cases show up in the first 1–2 years. But in a small number of people, scar tissue at the junction, a residual narrowing at the suture line, or a crossing vessel that becomes prominent later can lead to a new obstruction years afterward.

There is no guideline-level recommendation for redo pyeloplasty in adults; the information below is a review based on Campbell-Walsh and center case series, is DRAFT text awaiting physician review, and figures vary by center.

• Because Doç. Dr. Issı is an adult urology specialist alongside pediatric urology, re-evaluation and redo repair for adults operated on in childhood — whether with us or elsewhere — can be handled by the same team.

Some persistent widening is normal in a kidney that has had surgery; the hydronephrosis isn't expected to disappear completely. So seeing widening on ultrasound doesn't by itself mean recurrence. The real questions are whether the widening is increasing, whether function is dropping, and whether there are symptoms.

Redo pyeloplasty performed after a failed pyeloplasty (open, laparoscopic, or robotic) is reported at roughly 85–95% success in the literature. Working in a scarred area is harder; the magnified view and dexterity of robotic surgery can be a reason to prefer it in these cases, though open surgery remains a valid option too.

• Redo pyeloplasty (laparoscopic/robotic/open): roughly 85–95% success; first choice in most cases.
• Endopyelotomy: for a selected short narrowing; roughly 40–70% success.
• Ureterocalicostomy: for a small intrarenal pelvis or severe scarring.
• Nephrectomy: rare, for very low function with an ongoing problem.

A JJ (double-J) stent is generally placed for a redo repair and stays in for roughly 4–6 weeks depending on the center; in adults it's usually removed by cystoscopy under local anesthesia. With a stent in place, frequent urination, burning, mild bloody urine and flank pain when urinating are expected symptoms.

• With a stent in place: fever, severe pain, noticeable bleeding — see a doctor the same day.
• Fever, discharge from the wound, increasing pain, vomiting in the first weeks after surgery: don't wait.
• Flank pain with fever can mean an obstructed, infected kidney: same-day evaluation.

• Follow-up resembles that after the first operation: ultrasound around month 3, then every 6–12 months; MAG3 if there are symptoms or increasing widening. The simplest way to catch a silent recurrence early is for anyone operated on in childhood to have an occasional ultrasound check-up in adulthood.