Author/Authors :
Mohajerzadeh ، Leily Pediatric Surgery Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Khalili ، Mitra Mofid Children Hospital - Shahid Beheshti University of Medical Science , Shirvani ، Armin Virtual School of Medical Education and Management - Shahid Beheshti University of Medical Sciences , Sarafi ، Mehdi Pediatric Surgery Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Hajesmaeili ، Amin Pediatric Surgery Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Ebrahimi ، Gholamreza Pediatric Surgery Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Mohkam ، Masumeh Pediatric Nephrology Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Dalirani ، Reza Pediatric Nephrology Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Tabatabaee ، Mohamadtaghi Pediatric Nephrology Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Esfandiar ، Nasrin Pediatric Nephrology Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences , Mahdavi ، Nastaran Sadat Department of Anesthesiology - School of Medicine, Mofid Children s Hospital - Shahid Beheshti University of Medical Sciences , Hatefi ، Sayeh Pediatric Surgery Research Center, Research Institute for Children s Health - Shahid Beheshti University of Medical Sciences
Abstract :
Background: Newparameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair. Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery. Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 2.07 mm. The mean P/C ratio before surgery was 7.56 4.38. The mean preoperative split renal function was documented at 42.23%. The mean followup duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43mm. Themeankidney cortex diameter 6 months after surgery was 7.24mm. ThemeanP/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance halftime in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1. Conclusions: This study identified that PI in APD 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter.
Keywords :
Kidney Ultrasound , Pyeloplasty , Kidney Scans , Ureteropelvic Junction Obstruction
