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Aim: To determine the efficacy and outcome of pyeloplasty in poorly functioning kidneys in the pediatric population and whether pyeloplasty could be offered as an upfront procedure in such patient population, instead of nephrectomy., Materials and Methods: A retrospective data analysis of 83 patients who underwent pyeloplasty in poorly functioning kidneys from 2010 to 2015 was performed. Success was defined based on improvement in symptoms, stable or improved function, and better drainage on post-operative Tc-99m Diethylene Triamine Pentaacetic acid scan instead of DTPA scan renography done after 3 months and yearly thereafter., Results: Eighty-three patients with a mean age of 6.8 ± 2.88 years with poor function on isotope renogram (<30%) were included in the study. Three patients were excluded in view of postoperative outflow obstruction. Out of the remaining 80 patients, 56 were male and 24 were female. They were divided into two groups based on preoperative differential renal function (DRF), Group I ( n = 26) having preoperative DRF of <10% and Group II ( n = 54) having preoperative DRF of 10%-30%. All patients underwent laparoscopic dismembered pyeloplasty with ureteral stenting. The mean DRF improved from 7.58 ± 2.39 to 29.71 ± 5.16 postoperatively in Group I. However, in Group II, DRF improved from 20.81 ± 5.68 to 37.25 ± 7.11 postoperatively. At a follow-up of 24 months, the overall success rate was 98%., Conclusion: Pyeloplasty gives good intermediate-term results even in extremely poorly functioning kidneys and an upfront pyeloplasty instead of nephrectomy should be offered to all pediatric patients irrespective of preoperative function., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Indian Association of Pediatric Surgeons.)

Double- J (JJ) stents are commonly used in urological procedures. Minor and self limiting complications are common following JJ stenting. Malpositioning of JJ stent into the vascular system is a rare and a possibly fatal complication. We are reporting a case of a malpositioned JJ stent in the inferior vena cava (IVC), during Boari flap procedure for post-hysterectomy uretereovaginal fistula. Patient had undergone hysterectomy three months previously, and had ureterovaginal fistula possibly due to iatrogenic intraoperative injury. Patient underwent right-sided ureteroneocystostomy with Boari flap one week previously at other institute. Patient was admitted in our institution with complaints of fever, pain in abdomen and vomiting. In view of the symptoms of the patient, cross-sectional imaging with computed tomography scan was done which revealed an intraoperatively malpositioned JJ stent in the IVC, and well healed Boari flap was seen.