Open Pyeloplasty Outcomes and Scar Assessment

We identified 368 children who had undergone open pyeloplasty between January 2008 and February 2022 at our department (full member of ERN eUROGEN). A total of 185 children (50.3%) were under 1 year of age at the time of surgery. Patients with other cause of hydronephrosis than ureteropelvic junction obstruction were excluded (e.g., secondary stenosis due to primary megaureter), or patients who underwent other surgery in the same term (e.g., pyeloplasty and circumcision). We also excluded patients with skin incision other than described below. A total of 162 children met the inclusion parameters, 124 boys (76.7%) and 38 girls (23.3%).
The medical records were retrospectively reviewed in terms of demographic data, operation time, level of experience of the surgeon, length of hospital stay, duration of stent placement, febrile urinary tract infection during ureteral stenting, ultrasound findings (grade of hydronephrosis according to a consensus group pediatric nephrology working society [18 (link)], anteroposterior pelvic diameter (APD), parenchyma thickness) before and after surgery in a standardized follow-up, separate renal function (SRF) in MAG3 as well as analgesia during hospital stay, intraoperative and postoperative complications according to Clavien–Dindo (CD), and inpatient readmission within 30 days. We also examined the need of a redo pyeloplasty.
Complications were regarded as any deviation from the expected postoperative course according to the five-grade Clavien–Dindo classification [19 (link)].
In the second part of this study, a nonvalidated self-designed questionnaire (in German language) was sent in September 2022 to all included patients by mail to evaluate the postoperative course from the parents’ point of view, as well as the satisfaction in the long-term course. Additionally, they were asked to take a photo of the scar alongside a metric ruler to obtain scar length values. The parents were asked to return the completed questionnaire and the photo of the scar either by mail (prepaid envelope enclosed) or by e-mail within 4 weeks (Supplementary Data Figure S1).
In the third part, these photos were independently categorized by 2 experienced surgeons using a modified Vancouver Scar Scale [20 (link)]. The scale was modified for usage on photographs and linear scars. Instead of measuring the height, it was described as flat, slightly raised, fairly raised, bulging, and sunken. Pliability was left out as it is not representable on photographs. The higher the scoring, the worse the cosmesis, whereby the maximum score of 9 reflects the worst imaginable scar. The lowest scores (0–2) reflect the best imaginable scar or almost normal skin (Supplementary Data Figure S2).