1159 99M TECHNETIUM DIMERCAPTO-SUCCINIC ACID RENAL SCINTIGRAPHY ABNORMALITIES FOLLOWING URINARY DIVERSION LONG TERM FOLLOW UP AFTER ORTHOTOPIC BLADDER SUBSTITUTION WITH EXTRAMURAL SEROUS LINED URETERAL REIMPLANTATION

Abstract

INTRODUCTION AND OBJECTIVES: To determine the incidence and associated characteristics of renal abnormalities utilizing 99m Technetium Dimercapto-succinic acid (DMSA) renal scintigraphy in patients who completed minimal 10 year follow up after extramural serous-lined ureteral reimplantation METHODS: Between January 1992 and June 1998, 311 consecutive patients underwent an ileal w neobladder orthotopic urinary diversion with extramural serous-lined uretero-ileal anastomosis. Utilizing our prospectively maintained database, patients who were living free of malignancy and completed 10 years of follow up were identified (113Patients). All patients were radiologically evaluated by an ultrasound scan, ascending pouchogram. Patients with evidence of pouchoureteric reflux were evaluated by MAG 3 Renogram and 99mTc-DMSA scan. RESULTS: Ascending pouchogram revealed pouchoureteric reflux in 27 patients [30 renal units (13.6%) ]. These patients were evaluated by 99mTc-DMSA scan [52 renal units] Reflux grade was IV or V, II or III and I in 5, 18 and 7 of the 30 refluxing renal units, respectively. 99mTc-DMSA renal scintigraphy revealed parenchymal abnormalities in 22 renal units [(17 of the 30 refluxing renal units (54.1%)]. We noted differential uptake less than 40% with and without cortical defects in 10 and 7 refluxing units. Ultrasound showed pyelonephritic changes in 7 of the 17 patients (41%) in whom 99mTc-DMSA scintigraphy was abnormal. On multivariable analysis, risk factors significantly associated with 99mTc-DMSA scan renal parenchymal abnormalities (Grade III or more) were Diabetes, nephroithiasis, history of pyelonephritis and Grade III or more pouchoureteric reflux (p 0.05). CONCLUSIONS: After minimal 10 year follow up, around 35 % of the renal units develop renal parenchymal abnormalities detected by 99mTc-DMSA. Pouchoureteic reflux is a significant predictor of renal scarring on the long term.