Screening Ultrasound in Follow-up After Pediatric Pyeloplasty
Received 12 July 2009; accepted 24 September 2009. published online 10 March 2010.
Objectives
To investigate whether an initial ultrasound (US) adequately identifies those patients who need further investigation and possibly intervention while decreasing instrumentation and radiation exposure. The recommended imaging after pediatric pyeloplasty has included intravenous pyelography, radionucleotide renography, and ultrasound US.
Methods
We retrospectively reviewed pediatric open pyeloplasty cases performed between 1999 and 2007. Of 116 patients reviewed, 49 met the inclusion criteria of unilateral pyeloplasty with pre- and postoperative US and mercaptoacetyltriglycine (MAG-3). Hydronephrosis was judged by anterior posterior pelvic diameter and caliectasis. Change in renal function on MAG-3 was defined as increase or decrease in function >5%.
Results
Of 49 patients, 42 (85.7%) showed improved or stable hydronephrosis postoperatively and 7 (14.3%) showed increased hydronephrosis. Forty-six (93.8%) patients had either improved or stable renal function. Of 42 patients with stable or improved hydronephrosis, 41 (97.6%) also had stable or improved function. Comparatively, of 7 patients with increasing hydronephrosis, 2 (28.6%) showed deteriorated renal function, P = .05.
Conclusions
Postpediatric pyeloplasty imaging should aim to identify those who require further intervention. Our data demonstrate that at-risk patients can be identified with a sentinel US and selectively determine who needs further MAG-3 investigation. This should increase compliance while decreasing costs, instrumentation, and radiation exposure.
aDepartment of Urology, University of Texas, Southwestern Medical Center and Children's Medical Center, Dallas, Texas
bDivision of Urology, Department of Surgery, University of Colorado School of Medicine and The Children's Hospital, Denver, Colorado
Reprint requests: Duncan T. Wilcox, M.B.B.S., M.D., The Children's Hospital, 13123 East 16th Ave B463, Aurora, CO 80045
ABSTRACT