Optimizing Pyeloplasty Outcomes: Defining Success and Guiding Postoperative Ultrasound Follow-Up

Patients with ureteropelvic junction obstruction (UPJO) often undergo pyeloplasty to improve kidney function and alleviate symptoms like flank pain. However, clear definitions of operative success post-surgery are lacking in current guidelines and literature. This study evaluated the key factors that define composite pyeloplasty success in 216 patients treated from 2015 to 2023 across a multi-institutional hospital system. The factors assessed for success included improvements in flank pain, split kidney function, nuclear scan T½, reduction in hydronephrosis, avoidance of reoperation, and creatinine levels. These indicators were used to identify the most significant markers of overall surgical success, to help guide postoperative follow-up. The composite success variable was based on a decision flowchart, with univariate analysis revealing that improvement in flank pain, hydronephrosis, and absence of reoperation were the most predictive of success (F1 scores ≥0.78). Notably, nuclear scan data, particularly the T½ value, had limited predictive power, suggesting that renal imaging could be deferred in straightforward cases to avoid unnecessary procedures. Ultrasound was incorporated in assessing hydronephrosis as a key marker for post-surgical success, emphasizing its role as a non-invasive and effective imaging modality for tracking recovery. These findings highlight that improvements in flank pain and hydronephrosis may be the most reliable indicators of pyeloplasty success in patients who do not require reoperation. Future studies should focus on expanding the population sample and conducting prospective trials to better define success and refine postoperative imaging protocols, particularly the utility of ultrasound and renal scans in long-term follow-up.