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The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

The operative mortality is about 1–2%. For those undergoing clearance of coeliac and superior mesenteric arteries, diarrhoea has been a particular problem. At the present time age and stage are the main determinants of survival — age under 1 year and low stage are associated with an improved outcome. For those with localized tumours survival is in the region of 90–100%. The role of surgery in managing those with locally advanced or metastatic disease is unclear. However, recent evidence suggests that complete excision confers a survival advantage for those with stage 3 disease, although it is not clear that complete excision improves survival in those with metastatic disease. This remains at about 30%.

The history of the treatment of patients with a Wilms tumour is one of the most impressive success stories in pediatric surgery. While in 1941 W.E. Ladd reported a survival rate of 20%, today the relapse-free survival is close to 90% in all patients, and even 66% in the histologically high risk group. Results of the NWTS (primary surgery) and the SIOP (primary chemotherapy — with or without tumour biopsy) are similar: the rate of complications and tumour rupture is significantly higher with the primary surgery strategy. Long-term follow-up is important to detect early a metachronous tumour in the contralateral kidney. Synchronous bilateral tumours have an incidence of about 10% and after initial biopsy, chemotherapy should be instituted and then partial nephrectomy carried out as well as lumpectomies. This has been found to be effective in the past. There is no place for total nephrectomy in these patients. Biopsy only and chemotherapy is indicated in patients with diffuse nephroblastomatosis; however, long-term follow-up is also crucial because late Wilms tumour occurrence is known. Recently, experiences with kidney-sparing surgery in unilateral Wilms tumours have been reported in patients with excellent response to pre-operative chemotherapy.

Recurrences are most likely due to proliferation of residual epithelium from cysts or sinuses. The surgical procedure should thus be performed electively soon after diagnosis. Infected cysts and sinuses are treated with antibiotics until the inflammatory signs subside, unless abscess formation mandates incision and drainage. Repeated infections render identification of the tissue layers much more difficult. Surgery after infections of remnants of the first branchial pouch carries an increased risk of facial nerve injury. In order to avoid damage to vital vascular and nerve structures it is important to confine dissection close to the sinus tract.

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

Endoscopic treatment is a simple, safe and effective procedure in the management of all grades of reflux. Procedure-related complications are rare. The only significant complication with this procedure has been failure. This may be initial failure, i.e., the reflux is not abolished by the injection, or recurrence, where initial correction is not maintained. About 15–20% of refluxing ureters require more than one endoscopic injection of paste to correct the condition. Apart from failure to correct reflux, vesicoureteric junction obstruction is the only other reported complication following STING. A recent multicentre survey of STING procedures in 12,251 ureters in 8,332 patients revealed vesicoureteric junction obstruction in 41 ureters (0.33%) requiring reimplantation of ureters.

Duplication of the renal pelvis and ureters is the commonest anomaly of the upper urinary tract. It occurs in approximately 0.8% of the population and in 1.8–4.2% of pyelograms. Commonly these are asymptomatic. However, they can challenge the diagnostic acumen with a wide variety of manifestations.

Duplication of the renal pelvis and ureters is the commonest anomaly of the upper urinary tract. It occurs in approximately 0.8% of the population and in 1.8–4.2% of pyelograms. Commonly these are asymptomatic. However, they can challenge the diagnostic acumen with a wide variety of manifestations.