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• W2067672682 abstract "No AccessJournal of UrologyPediatric Urology1 Sep 2010Is Routine Renography Required After Pyeloplasty? Fayez Almodhen, Roman Jednak, John-Paul Capolicchio, Waleed Eassa, Alex Brzezinski, and Mohamed El-Sherbiny Fayez AlmodhenFayez Almodhen More articles by this author , Roman JednakRoman Jednak More articles by this author , John-Paul CapolicchioJohn-Paul Capolicchio More articles by this author , Waleed EassaWaleed Eassa More articles by this author , Alex BrzezinskiAlex Brzezinski More articles by this author , and Mohamed El-SherbinyMohamed El-Sherbiny More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.05.017AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed whether renography should be performed routinely following pyeloplasty. Materials and Methods: We identified the records of all patients undergoing pyeloplasty at our hospital between 1989 and 2005. Patients were eligible for the study if they had undergone preoperative ultrasound and renal scan, and postoperative ultrasound and renal scan within 3 months and 1 year postoperatively, respectively. Patients were excluded if they had associated anomalies or high grade reflux. Postoperative downgrading or decompression of the pelvicaliceal dilatation within the same grade was recorded as “improved,” while unchanged or worsening hydronephrosis was recorded as “no improvement.” All information was obtained from the official radiologist reports rather than from the postoperative surgeon notes. Data obtained from the postoperative renal scan included the presence or absence of obstruction as well as split renal function. We compared postoperative ultrasound and renal scan, as well as changes between preoperative and postoperative split renal function in patients with a normal contralateral kidney. Fisher's exact test was used for comparison. Results: A total of 97 patients who underwent 101 pyeloplasties at a median age of 18 months were eligible for review. Mean ± SD followup was 4.5 ± 2 years. Of the 91 kidneys with improvement on postoperative ultrasound 2 (2%) had an obstructive postoperative renal scan, which spontaneously resolved during followup. In contrast, of the 10 kidneys with postoperative ultrasound showing no improvement 4 (40%) had an obstructive renal scan, of which 2 (50%) required a second procedure (p <0.001). Of the 46 kidneys with downgraded hydronephrosis none had an obstructive postoperative renal scan, compared to 6 of 55 (11%) without downgrading (p <0.03). Of the 49 patients with preoperative split renal function greater than 45% none demonstrated changes of more than 5% postoperatively, compared to 15 of 35 (43%) with split renal function less than 45% (p <0.001). Conclusions: Patients in whom postoperative ultrasound reveals downgrading may not require postoperative renal scan to rule out obstruction. However, those with preoperative function less than 45% may exhibit functional changes greater than 5% that can be determined by postoperative renal scan. References 1 : Postnatal management of infants with antenatally detected hydronephrosis. Pediatr Nephrol2005; 20: 1253. Google Scholar 2 : Early diuresis renogram findings predict success following pyeloplasty. J Urol2001; 165: 2311. Link, Google Scholar 3 : Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J Urol1995; 154: 1889. Link, Google Scholar 4 : Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol2002; 168: 1118. Link, Google Scholar 5 : The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol2000; 164: 1101. Link, Google Scholar 6 : Long-term followup of pediatric dismembered pyeloplasty: how long is long enough?. J Urol2003; 169: 1809. Link, Google Scholar 7 : Prolonged follow-up after paediatric pyeloplasty: are repeat scans necessary?. BJU Int2007; 100: 1150. Google Scholar 8 : Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol1993; 23: 478. Crossref, Medline, Google Scholar 9 : Pyeloplasty improves renal function and somatic growth in children with ureteropelvic junction obstruction. J Urol1995; 154: 218. Link, Google Scholar 10 : Comparison of the diuretic renogram and the pressure perfusion study in children. J Urol1985; 134: 92. Link, Google Scholar 11 : Postoperative diuresis renography and ultrasound in patients undergoing pyeloplasty: Predictors of surgical outcome. Clin Nucl Med1993; 18: 872. Crossref, Medline, Google Scholar 12 : Delayed decrease in differential renal function after successful pyeloplasty in children with unilateral antenatally detected hydronephrosis. Int J Urol2007; 14: 488. Google Scholar 13 : Calyx to parenchyma ratio in pelvi-ureteric junction obstruction. BJU Int2002; 89: 73. Crossref, Medline, Google Scholar Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHsi R, Holt S, Gore J, Lendvay T and Harper J (2015) National Trends in Followup Imaging after Pyeloplasty in Children in the United StatesJournal of Urology, VOL. 194, NO. 3, (777-782), Online publication date: 1-Sep-2015.Hsi R, Holt S, Gore J and Harper J (2014) Trends in Followup Imaging after Adult PyeloplastyJournal of Urology, VOL. 191, NO. 5, (1357-1362), Online publication date: 1-May-2014.Harraz A, Helmy T, Taha D, Shalaby I, Sarhan O, Dawaba M and Hafez A (2013) Changes in Differential Renal Function after Pyeloplasty in ChildrenJournal of Urology, VOL. 190, NO. 4S, (1468-1473), Online publication date: 1-Oct-2013.Romao R, Farhat W, Pippi Salle J, Braga L, Figueroa V, Bägli D, Koyle M and Lorenzo A (2012) Early Postoperative Ultrasound After Open Pyeloplasty in Children with Prenatal Hydronephrosis Helps Identify Low Risk of Recurrent ObstructionJournal of Urology, VOL. 188, NO. 6, (2347-2353), Online publication date: 1-Dec-2012. Volume 184Issue 3September 2010Page: 1128-1133 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordskidneyurologic surgical proceduresradioisotope renographyhydronephrosisureteral obstructionMetricsAuthor Information Fayez Almodhen More articles by this author Roman Jednak More articles by this author John-Paul Capolicchio More articles by this author Waleed Eassa More articles by this author Alex Brzezinski More articles by this author Mohamed El-Sherbiny More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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