Three-dimensional reconstruction by a computer-assisted surgery system for pediatric hydronephrosis caused by accessory renal artery compression: a single-center retrospective observational comparative case series.

BACKGROUND

Ureteropelvic junction obstruction (UPJO) is the most common cause of pediatric hydronephrosis. For surgeons, a precise preoperative evaluation is essential, especially for hydronephrosis caused by accessory renal artery (ARA) compression. Conventional imaging modalities (ultrasound, magnetic resonance urography, computed tomography urography) often fail to identify the exact cause preoperatively, making precise surgical planning difficult. It is against this background that this case series is conducted. This is a single-center retrospective observational comparative case series to evaluate the clinical value of computer-assisted surgery system (CAS) three-dimensional (3D) reconstruction in children with hydronephrosis caused by ARA compression.

OBJECTIVE

To analyze and discuss the value of CAS 3D reconstruction in preoperative evaluation, surgical planning, and perioperative outcomes for pediatric hydronephrosis caused by ARA compression.

METHODS

This is a single-center retrospective observational comparative case series. A total of 263 children who underwent surgery for UPJO-related hydronephrosis were enrolled. By a retrospective review of preoperative imaging, medical records, and surgical documents, 20 patients with intraoperatively confirmed ARA compression were identified and divided into a 3D reconstruction group (n = 13) and a control group (n = 7). Preoperative etiological diagnosis, operative time, intraoperative blood loss, length of hospital stay, and complications were compared between the two groups.

RESULTS

All patients met surgical indications. Conventional imaging did not detect ARA compression preoperatively, whereas CAS 3D reconstruction identified ARA compression in all 13 patients of the 3D group. Operative time and intraoperative blood loss showed significant between-group differences [108 (98-128) vs. 128 (124-132) min, P = 0.002; 5 (4-8) mL vs. 8 (5-15) mL, P = 0.007]. Length of hospital stay was comparable [9 (7-11) vs. 9 (7-12) days, P = 0.838].

CONCLUSION

In this single-center retrospective observational comparative case series, CAS 3D reconstruction visualized ARA compression preoperatively and provided comprehensive anatomical information for surgical planning, while conventional imaging failed to detect such compression. It shows a significant association with favorable perioperative metrics in pediatric patients with ARA-related hydronephrosis.