Korean J Urol.  2008 Nov;49(11):1018-1023. 10.4111/kju.2008.49.11.1018.

Appropriate Follow-up Ultrasonography Interval after Pyeloplasty in Children with Ureteropelvic Junction Obstruction

• Park SJ
• Kim YS
• Lee HY
• Han SW

• KMID: 1328175
• DOI: http://doi.org/10.4111/kju.2008.49.11.1018

Abstract

PURPOSE: Serial ultrasonography(US) is routinely performed after pyeloplasty in the setting of pediatric ureteropelvic junction obstruction(UPJO). We evaluated the adequacy of the follow-up US interval we are currently using, which calls for US at 1, 3, 6, 9, and 12 months following surgery.
MATERIALS AND METHODS
Between January 2002 and August 2005, 102 patients underwent dismembered pyeloplasty for unilateral UPJO. Within this group, we selected 95 patients with high grade hydronephrosis to participate in this study. The degree of hydronephrosis was graded according to the classification issued by the Society for Fetal Urology(SFU). Improvement was defined as at least one grade of reduction. Serial sonograms were performed at 1, 3, 6, 9, and 12 months postoperatively.
RESULTS
On follow-up US, 33.7%, 69.5%, 77.9%, 80.0%, and 83.2% of the patients showed improvement in their hydronephrosis at 1, 3, 6, 9, and 12 months, respectively. One patient presented with aggravation at 1 month. However, at 3 months, this patient had returned to the preoperative grade. There was no significant difference between the mean hydronephrosis grades at 6 and 12 months. No patient showed hydronephrosis aggravation at the 12-month follow-up examination.
CONCLUSIONS
US at 1, 3, and 6 months revealed significant improvements in hydronephrosis. However, no significant change in hydronephrosis occurred beyond 6 months. Therefore, US performed between 6 and 12 months after pyeloplasty may be inefficient, and we propose follow-up US at the following time points: 1 month, 3 to 6 months, 12 months, and then annually.

Keyword

Ureteral obstruction; Hydronephrosis; Ultrasonography

MeSH Terms

Child
Male
Female
Humans

Figure

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  Fig. 1 Change in hydronephrosis on serial renal ultrasonography after pyeloplasty (Numbers on the graph indicate numbers of patients).

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  Fig. 2 Postoperative changes in the hydronephrosis grade in patients exhibiting grade 3 or 4 hydronephrosis preoperatively (The degree of hydronephrosis was graded according to the classification of the Society for Fetal Urology).

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  Fig. 3 Postoperative changes in hydronephrosis grade according to age at the time of pyeloplasty (The degree of hydronephrosis was graded according to the classification of the Society for Fetal Urology).

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