Korean J Urol.  2009 Jun;50(6):596-601. 10.4111/kju.2009.50.6.596.

Difference in Results of Ultrasonography and Diuretic Renograms after Pyeloplasty in Children with Unilateral Ureteropelvic Junction Obstruction

• Park S
• Ji YH
• Park KH
• Han DH
• Kim KS

• KMID: 1989793
• DOI: http://doi.org/10.4111/kju.2009.50.6.596

Abstract

PURPOSE: Controversies persist on pyeloplasty follow-up, and the aim of this study was to assess the differences and interpretations in results of postoperative ultrasonography and diuretic renograms.
MATERIALS AND METHODS
The study population consisted of 46 patients who underwent pyeloplasty between 1997 and 2003. The average patient age was 7.0 months (range, 2-36 months). Serial changes in hydronephrosis were evaluated by consecutive ultrasonography at 1, 4, 10, and 24 months after pyeloplasty, and a diuretic 99mTc-MAG3 renal scan was performed 4 months after the surgery.
RESULTS
Ultrasonography showed that 11 (24%), 27 (59%), 35 (76%), and 39 (89%) patients had improved in hydronephrosis at 1, 4, 10, and 24 months after pyeloplasty, respectively. Diuretic renal scans showed that of 27 patients who showed improvements in hydronephrosis at 4 months after pyeloplasty, only 17 (63%) had improved excretion and 22 (81%) had preservation of different renal function (DRF). Among 19 patients with persistent or worsened hydronephrosis, 10 (53%) had improved excretion and 13 (68%) had preserved DRF.
CONCLUSIONS
The results of ultrasonography and diuretic renal scan studies can differ in the same case after pyeloplasty. We recommend that improvements in hydronephrosis be assessed individually by ultrasonography, renal scans, and clinical status to determine surgical outcomes.

Keyword

Child; Hydronephrosis; Ureteral obstruction; Ultrasonography

MeSH Terms

Child
Follow-Up Studies
Humans
Hydronephrosis
Technetium Tc 99m Mertiatide
Ureteral Obstruction
Technetium Tc 99m Mertiatide

Figure

• 

  Fig. 1 Immediate changes in hydronephrosis on ultrasonography after pyeloplasty. Two patients showing no change (a) underwent repeat operations at 4 and 5 months after pyeloplasty, respectively.

• 

  Fig. 2 Changes in different renal function according to urinary excretion (at 4 months after pyeloplasty).

Reference

1. Van Cangh PJ. Is it always necessary to treat a ureteropelvic junction syndrome? Curr Urol Rep. 2007. 8:118–121.

2. Neste MG, du Cret RP, Finlay DE, Sane S, Gonzalez R, Boudreau RJ, et al. Postoperative diuresis renography and ultrasound in patients undergoing pyeloplasty. Predictors of surgical outcome. Clin Nucl Med. 1993. 18:872–872.

3. Paduano L, Carini C, Alessandrini H. Validity of ultrasonography for postoperative monitoring in pediatric urology. J Urol. 1996. 155:1053–1056.

4. Carr MC, El-Ghoneimi A. Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ, editors. Anomalies and surgery of the ureteropelvic junction in children. Campbell-Walsh urology. 2007. 9th ed. Philadelphia: Saunders;3359–3382.

5. Amling CL, O'Hara SM, Wiener JS, Schaeffer CS, King LR. Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: long-term outcome in 47 renal units. J Urol. 1996. 156:2020–2024.

6. Park S, Ji YH, Park YS, Kim KS. Change of hydronephrosis after pyeloplasty in children with unilateral ureteropelvic junction obstruction. Korean J Urol. 2005. 46:586–592.

7. Fernbach SK, Maizels M, Conway JJ. ultrasonography grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993. 23:478–480.

8. Conway JJ. "Well-tempered" diuresis renography: its historical development, physiological and technical pitfalls, and standardized technique protocol. Semin Nucl Med. 1992. 22:74–84.

9. Oh SJ, Moon DH, Kang W, Park YS, Park T, Kim KS. Supranormal differential renal function is real but may be pathological: assessment by 99m technetium mercaptoacetyltriglycine renal scan of congenital unilateral hydronephrosis. J Urol. 2001. 165:2300–2304.

10. Salem YH, Majd M, Rushton HG, Belman AB. Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J Urol. 1995. 154:1889–1893.

11. Bernstein GT, Mandell J, Lebowitz RL, Bauer SB, Colodny AH, Retik AB. Ureteropelvic junction obstruction in the neonate. J Urol. 1988. 140:1216–1221.

12. Aliabadi H, Ami Sidi A, Gonzalez R. Management of ureteropelvic junction obstruction in infants and neonates. Eur Urol. 1988. 15:103–107.

13. Grignon A, Filiatrault D, Homsy Y, Robitaille P, Filion R, Boutin H, et al. Ureteropelvic junction stenosis: antenatal ultrasonographic diagnosis, postnatal investigation, and follow-up. Radiology. 1986. 160:649–651.

14. Park SJ, Kim YS, Lee HY, Han SW. Appropriate follow-up ultrasonography Interval after pyeloplasty in children with ureteropelvic junction obstruction. Korean J Urol. 2008. 49:1018–1023.

15. Shokeir AA, El-Sherbiny MT, Gad HM, Dawaba M, Hafez AT, Taha MA, et al. Postnatal unilateral pelviureteral junction obstruction: impact of pyeloplasty and conservative management on renal function. Urology. 2005. 65:980–985.

16. Pohl HG, Rushton HG, Park JS, Belman AB, Majd M. Early diuresis renogram findings predict success following pyeloplasty. J Urol. 2001. 165:2311–2315.

17. Chertin B, Fridmans A, Knizhnik M, Hadas-Halperin I, Hain D, Farkas A. Does early detection of ureteropelvic junction obstruction improve surgical outcome in terms of renal function? J Urol. 1999. 162:1037–1040.

18. Chandrasekharam VV, Srinivas M, Bal CS, Gupta AK, Agarwala S, Mitra DK, et al. Functional outcome after pyeloplasty for unilateral symptomatic hydronephrosis. Pediatr Surg Int. 2001. 17:524–527.

19. McAleer IM, Kaplan GW. Renal function before and after pyeloplasty: Does it improve? J Urol. 1999. 162:1041–1044.

20. Bonnard A, Fouquet V, Carricaburu E, Aigrain Y, El-Ghoneimi A. Retroperitoneal laparoscopic versus open pyeloplasty in children. J Urol. 2005. 173:1710–1713.

21. Houben CH, Wischermann A, Borner G, Slany E. Outcome analysis of pyeloplasty in infants. Pediatr Surg Int. 2000. 16:189–193.

22. Stein R, Ikoma F, Salge S, Miyanaga T, Mori Y. Pyeloplasty in hydronephrosis: examination of surgical results from a morphologic point of view. Int J Urol. 1996. 3:348–355.

23. Tapia J, Gonzalez R. Pyeloplasty improves renal function and somatic growth in children with ureteropelvic junction obstruction. J Urol. 1995. 154:218–222.