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Follow-up imaging after pediatric pyeloplasty

Manoj Kumar1, Sanjeet Kumar Singh1, Sohrab Arora1

  • 1Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Indian Journal of Urology : IJU : Journal of the Urological Society of India
|August 25, 2016
PubMed

Insights

Pediatric pyeloplasty follow-up can be simplified. Children with good initial split renal function (SRF) and non-obstructive results at 3 months post-surgery may not need further radiographic monitoring.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Radiology

Background:

  • Radiographic follow-up protocols after pediatric pyeloplasty are not standardized.
  • This study aimed to define optimal follow-up methods for children undergoing pyeloplasty.

Purpose of the Study:

  • To prospectively evaluate children undergoing pyeloplasty to determine the most effective follow-up strategy.
  • To identify criteria for discontinuing radiographic monitoring after successful pyeloplasty.

Main Methods:

  • 145 children with unilateral ureteropelvic junction obstruction underwent pyeloplasty between 2000-2008.
  • Preoperative ultrasound (USG) and diuretic renal scan (RS) determined split renal function (SRF) and divided patients into four groups.
  • Follow-up included serial USG and RS for up to 5 years, assessing hydronephrosis and SRF changes.

Main Results:

  • In Group I (SRF >40%), 85% showed no significant SRF change post-surgery.
  • Groups II, III, and IV (SRF <40%) had higher rates of SRF change (>5%).
  • Only 5 patients experienced failure, primarily in lower SRF groups; no deterioration occurred in Group I or II.

Conclusions:

  • Children with baseline split GFR >30% undergoing pyeloplasty require no further follow-up if 3-month postoperative diuretic renogram and USG show non-obstructive drainage (t½ <20 min) and reduced hydronephrosis.
  • This suggests a potential for de-escalation of surveillance in select pediatric pyeloplasty cases.
Abstract

Keywords:
Childrenfollow-uppyeloplastyrenal scans

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