Diagnosis Of Ureteropelvic Junction Obstruction Research Articles

Comparison of Urinary Biomarkers in Diagnosis of Ureteropelvic Junction Obstruction and Differentiation from Nonobstructive Dilatation.

Differentiation of nonobstructive dilatation (NOD) from ureteropelvic junction obstruction (UPJO) is a challenge in children with antenatally detected hydronephrosis. The aim of this study is to compare the utility of urinary biomarkers: carbohydrate antigen (CA 19-9), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule (KIM) in diagnosing UPJO. A prospective study was conducted after obtaining ethical clearance between 2021 and 2022. Group 1 - control group (n = 30): children with normal antenatal ultrasound with no urinary symptoms. Group 2 - study group (n = 48): children with unilateral hydronephrosis: Group 2a - NOD (n = 24): children stable on ultrasound and diuretic renogram and Group 2b - UPJO (n = 24): children who worsened to Grade 4 hydronephrosis on ultrasound/worsening of differential renal function (10% drop) on renogram who underwent pyeloplasty. Urinary biomarkers NGAL, KIM-1, and CA 19-9 were measured using the enzyme-linked immune absorbent assay method. The urine CA 19-9 level was 128.05 ± 4.08 U/mL in the UPJO group, and this was significantly higher (P = 0.001) than NOD, 70.29 ± 4.41, and controls, 1.91 ± 1.57. The urine NGAL level was 21.41 ± 4.44 pg/mL in UPJO, and this was significantly higher than controls, 2.669 ± 0.513, but not NOD, 24.55 ± 2.67. The urine KIM level was 817 ± 15.84 pg/mL in the UPJO group, and this was significantly higher than controls, 285 ± 8.10, but not NOD, 768.23 ± 15.12. Receiver operating characteristic analysis of CA 19-9 revealed a urine biomarker cutoff of 95 U/mL for diagnosing UPJO (sensitivity 95%; specificity 96%; and area under the curve 0.99). CA 19-9 is a superior marker compared to NGAL and KIM in differentiating UPJO from NOD. Further studies with larger numbers are warranted.

Decreased percent change in renal pelvis diameter on diuretic functional magnetic resonance urography following administration of furosemide may help characterize unilateral uretero-pelvic junction obstruction

A well-established definition of obstruction in the setting of congenital hydronephrosis is lacking. Multiple imaging modalities and radiographic characteristics or parameters have been described to help confirm the diagnosis of ureteropelvic junction obstruction (UPJO). We sought to evaluate the change in anterior-posterior renal pelvic diameter (APRPD) following furosemide administration in patients with unilateral hydronephrosis and confirmed UPJO on functional magnetic resonance urography (fMRU) who underwent pyeloplasty. There were 49 patients who met inclusion criteria (11 females, 38 males; average age 2.2 years, SD 3.4 years) from February 2006 to September 2020, diagnosed with unilateral hydronephrosis (SFU Grade 3-4) who underwent fMRU prior to pyeloplasty for confirmed UPJO. 29 of the included patients also underwent a post-pyeloplasty fMRU. A weight-adjusted dose of 1mg/kg of furosemide (max 20mg/kg) was administered intravenously. Two board-certified pediatric radiologists measured the APRPD of the obstructed and non-dilated kidneys prior to pyeloplasty and APRPD of the hydronephrotic kidneys on the post-pyeloplasty follow up fMRUs. Measurements were performed on images prior to and approximately 30min following furosemide injection. The average APRPD before furosemide injection in the obstructed kidney prior to pyeloplasty was 26.3mm (SD 9.0mm) compared to the non-dilated (not obstructed) kidney measurement of 5.1mm (SD 3.6mm) (p<0.001). Following administration of furosemide, the average APRPD was 31.4mm (SD 8.8mm) in the obstructed kidney, and 7.8mm (SD 4.1mm) in the non-dilated kidney (p<0.001). After pyeloplasty, the pre-furosemide APRPD measurement was 17.8mm (SD 11mm), which was significantly less compared to the pre-pyeloplasty APRPD (p<0.001). The post-pyeloplasty, post-furosemide APRPD measurement was 25.8mm (SD 12mm), also significantly less compared to the pre-pyeloplasty measurement (p=0.02). The changes in APRPD in the obstructed kidney prior to pyeloplasty was 5.1mm (SD 3.5mm) and after pyeloplasty was 8mm (SD 4.6mm) (p=0.002). Change in APRPD in the non-dilated kidney was 2.7mm (SD 2.3mm). Percent APRPD change in the obstructed kidney was 22.9% (SD 18.5%), which was significantly less than 33.3% (SD 22.1%) in the post-pyeloplasty kidney (p=0.028) and 82.8% (SD 87.9%) in the non-dilated kidney (p<0.001). A relatively smaller change in APRPD on fMRU following administration of furosemide in the setting of UPJO may serve as another predictive characteristic of obstructed kidneys.

What is the Critical age for the Improvement of Parenchymal Thickness after Pyeloplasty?

The most important point in cases of ureteropelvic junction obstruction (UPJO) is to decide on the need and timing of surgical treatment. Renal damage may become irreversible as the duration of the obstruction is prolonged. Worsening of hydronephrosis and decrease in renal parenchymal thickness after pyeloplasty may herald an irreversible renal damage. It is important to know at what age this damage begins. In this study, we aimed to determine the relationship between the age of the patients at the time of pyeloplasty performed for UPJO and parenchymal recovery. In our study, 156 patients (mean age: 43.5 months) who underwent pyeloplasty with the diagnosis of UPJO between 2007 and 2019 were evaluated retrospectively. Demographic characteristics, ultrasonographic (USG) and nuclear renal scintigraphy findings, previous surgeries ​of the patients were recorded. Numerical variables were evaluated statistically, and the best cut-off point was determined. Parenchymal thickening was determined as the most important criterion in postoperative renal recovery which was more evident at early ages. Based on statistical assessments , the cut-off age for renal parenchymal recovery was determined as 38 months. While parenchymal recovery was inadequate after pyeloplasty performed in patients older than 38 months, the most significant improvement in renal functions was seen in children younger than 13 months of age. Pyeloplasty should be performed in patients with UPJO before development of severe renal damage. Statistically, the best parameter to evaluate the recovery after pyeloplasty is the change in parenchymal thickness. With advancing age, it is impossible to reverse the obstructive nephropathy.

Can we improve the usefulness of the diuretic renogram in the diagnosis of ureteropelvic junction obstruction (UPJO) in children? Introduction of mercaptoacetyltriglycine-suspected obstruction scoring system (MAG-SOS)

Mercaptoacetyltriglycine (MAG-3) renogram is one of the gold standard diagnostic tools of ureteropelvic junction obstruction (UPJO); however, there is no widely agreed indications of pyeloplasty based on MAG-3 findings. In this study, we introduce a renogram scoring system that can help improve the prognostic value of MAG-3 renogram and in the decision making of pyeloplasty. We retrospectively reviewed consecutive pyeloplasties for antenatal hydronephrosis from 2010 to 2020. A control group was included of non-operatively managed SFU grade 3 and 4. The initial renal ultrasound and preoperative MAG-3 Lasix renogram were reviewed for differential renal function (DRF), type of renogram curve and tracer washout half-time (T1/2). A ROC curve was used to evaluate the cut-off points that can be associated with obstruction. A multivariate linear regression model was used to assess the best renogram parameter that can predict surgical intervention. We included 188 patients with 209 renal units. The median age for pyeloplasty was 5.4 months. The mercaptoacetyltriglycine-Suspected Obstruction Scoring System (MAG-SOS) was associated with pyeloplasty (AUC=0.97, P<0.001) (FigureA). A score of 5 is 100% specific for obstruction. 78% of units required surgical intervention had a MAG-SOS score of≥5 while all units of the control group had a range of score 0-4. Using the multivariate analysis, the MAG-SOS system showed to the only independent predictor for pyeloplasty (HR=0.03, p<0.001). This study has some limitations. Firstly, the retrospective nature of the cohort; however, all patients were reviewed by one investigator who was blinded to the line of management. This is a single institutional study; therefor, this MAG-SOS should be evaluated by other centers to ensure its efficiency. Lastly, the pyeloplasty decision was taken by 3 different urologists; nevertheless, all of them adopt the same indications which are similar to those of the Society for Pediatric Urology and the Canadian Urological Association guidelines. The MAG-SOS system showed to be a useful tool that can predict pyeloplasty. A score of 5 has 100% specificity for patients having a pyeloplasty performed. Prospective studies are required to confirm the usefulness of this novel tool.

Early detection of ureteropelvic junction obstruction in neonates with prenatal diagnosis of renal pelvis dilatation using 1H NMR urinary metabolomics

Renal pelvis dilatation (RPD) is diagnosed in utero on prenatal ultrasonography (US) and can resolve spontaneously. However, isolated RPD can also reflect ureteropelvic junction obstruction (UPJO), which requires surgical treatment to prevent progressive renal deterioration. The diagnosis of UPJO can only be confirmed after birth with repeat US and renal isotope studies. 1H Nuclear Magnetic Resonance spectroscopy (NMR) was performed on urine of newborns with prenatally diagnosed unilateral RPD and healthy controls to identify specific urinary biomarkers for UPJO. The original combination of EigenMS normalization and sparse partial-least-squares discriminant analysis improved selectivity and sensitivity. In total, 140 urine samples from newborns were processed and 100 metabolites were identified. Correlation network identified discriminant metabolites in lower concentrations in UPJO patients. Two main metabolic pathways appeared to be impaired in patients with UPJO i.e. amino acid and betaine metabolism. In this prospective study, metabolic profiling of urine samples by NMR clearly distinguishes patients who required surgery for UPJO from patients with transient dilatations and controls. This study will pave the way for the use of metabolomics for the diagnosis of prenatal hydronephrosis in clinical routine.

The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis.

To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults. Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density. Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively (p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.032). Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.

Transperitoneal Versus Retroperitoneal Robotic-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children. A Multicentre, Prospective Study

BackgroundRobotic-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among paediatric urologists. ObjectiveTo compare surgical variables and clinical outcomes, including complications and success rate, with RALP using the transperitoneal (T-RALP) and retroperitoneal (R-RALP) approaches. Design, setting, and participantsWe performed a multicentre, prospective, cohort study (NCT03274050) between November 2016 and October 2021 in three paediatric urology teaching centres (transperitoneal approach, n = 2; retroperitoneal approach, n = 1). The diagnosis of ureteropelvic junction obstruction (UPJO) was confirmed by renal ultrasound and mercaptoacetyltriglycine-3 renal scan or uro–magnetic resonance imaging with functional evaluation. The exclusion criteria were children <2 yr old, persistent UPJO after failed pyeloplasty, and horseshoe and ectopic kidney. InterventionWe performed dismembered pyeloplasty using running monofilament 6-0 absorbable suture. Outcome measurements and statistical analysisWe assessed intra- and postoperative morbidity (primary outcome) and success (secondary outcome). Data were expressed as medians and interquartile range (25th and 75th percentiles) for quantitative variables, and analysed comparatively. Results and limitationsWe operated on 106 children (T-RALP, n = 53; R-RALP, n = 53). Preoperative data were comparable between groups (median age 9.1 [6.2–11.2] yr; median weight 26.8 [21–40] kg). Set-up time (10 vs 31 min), anastomotic time (49 vs 73 min), and console time (97 vs 153 min) were significantly shorter with T-RALP than with R-RALP (p < 0.001). No intraoperative complications occurred. No conversion to open surgery was necessary. The median hospital stay was longer after T-RALP (2 d) than after R-RALP (1 d; p < 0.001). Overall, postoperative complication rates were similar. No failure had occurred at the mean follow-up of 25.4 (15.1–34.7) mo. ConclusionsIn selected children, RALP is safe and effective using either the transperitoneal or the retroperitoneal approach, with a shorter hospital stay after R-RALP. Patient summaryIn our multicentre, prospective study, we compared the results and complications of robotic-assisted laparoscopic pyeloplasty (RALP) using the transperitoneal and retroperitoneal approaches. We found that RALP is safe and effective using either approach, with a shorter hospital stay after R-RALP.

Potential benefits of functional magnetic resonance urography (fMRU) over MAG3 renal scan in children with obstructive uropathy

Functional renal imaging, most commonly with MAG3 nuclear medicine renal scan, is recommended in the evaluation of children with urinary tract dilation (UTD) suspected of obstructive uropathy. Alternatively, renal function can be evaluated with functional Magnetic Resonance Urography (fMRU), which has superior anatomic detail. However, there are not enough data comparing both methods' equivalency. In this study, we compare the functional and obstruction parameters of fMRU and MAG3 in a pediatric cohort presenting with obstructive uropathy. This is an IRB-approved retrospective review of all children undergoing fMRU at a single, free-standing children's hospital between May 2008 and September 2017. Patients who also underwent a MAG3 renal scan within 6 months and who had no interval surgical intervention were included in the study. Bladder catheterization was performed prior to both imaging studies. 735 children had 988 fMRU studies performed during the study period. 37 unique patients (13 girls and 24 boys) with median age of 6 months (range: 2 mo-19y) were included in the final sample. Median time interval between studies was 70 days (range 6-179 days). The majority of participants (26/37, 70.3%) presented with UTD P3 and had diagnosis of uretero-pelvic junction obstruction (UPJO) in 21/37. Differential renal function (DRF) was used to group 10 fMRU and 9 MAG3 patients as normal; 9 fMRU and 11 MAG3 as mild; 11 fMRU and 6 MAG3 as moderate; and 7 fMRU and 6 MAG3 as severe; Wilcoxon signed-rank test (p=0.5106). Results were similar for DRF among patients with and without duplex kidneys. In the analysis of obstruction, using reference standard T½ MAG3≥20min, a greater or equal than 6min renal transit time (RTT) from fMRU showed a specificity of 94%, a sensitivity of 62%, and an AUC of 0.827. The differential renal function determined by MAG3 and fMRU in children was not statistically different, therefore we concluded that it was similar and potentially equivalent. Better correlation was shown in patients who had normal split kidney function. While the tests are clinically equivalent, the variability of DRF within each clinical category (i.e., normal, mild, moderate, severe) is not surprising, because MAG3 does not clearly differentiate the dilated collecting system from the functional parenchymal tissue, while fMRU does. Using MAG3 as the gold standard, fMRU was 94.74% specific and 5% more sensitive in detecting UPJO with a RTT of 6min vs. 8min.

Сравнение функциональной магниторезонансной урографии и динамической нефросцинтиграфии в функциональной оценке обструкции пиелоуретерального сегмента у детей

PURPOSE In order to determine the role and significance of functional magnetic resonance urography (fMRU) in the diagnosis of ureteropelvic junction obstruction (UPJO), a comparative analysis of the results of fMRU and dynamic renal scintigraphy (DRS) was carried out. MATERIALS AND METHODS From January 2017 to December 2019, fMRU and diuretic DRS were performed in 36 patients (mean age 89+/-63 months). Boys - 26 (72.2%), girls - 10 (27.8%). Left-sided hydronephrosis was detected in 23 (63.9%) children, right-sided in 12 (33.3%) patients, and bilateral lesions in 1 (2.8%) patient (2 renal units (RU)). Antenatal hydronephrosis was detected in 9 (25%) patients, and postnatally in 27 (75%) patients. According to ultrasound data, grade II hydronephrosis occurred in 11 (29.8%) RU, grade III - in 21 RU (56.7%), and grade IV - in 5 RU (13.5%) according to the SFU classification. A diuretic test was performed in 26 patients. RESULTS Median and quartiles of differential renal function (DRF) according to fMRU data on the affected side were 37% [29; 43], and according to DRS - 46% [40;49]. When performing fMRU, a positive diuretic test was detected in 20 patients, 5 patients - negative and 1 patient - doubtful, and according to the DRS data, 12 patients had a positive test, 10 patients - negative and 4 patients - doubtful. Differences in DRF between fMRU and DRS varied between 0.7-33%. The average value of differences in DRF on the affected side was 11.3+/-8.5%. When comparing the results of DRF on the affected side, a moderate correlation was found on the Cheddock scale (r=0.59, p<0.05) between fMRU and DRS data. In comparison of the DRF using the Wilcoxon test, statistically significant differences were revealed (p<0,05). SUMMARY Our experience demonstrates the high potential of fMRU in terms of replacing the classical methods of diagnosis of UPJO in children, taking into account the high correlation coefficients between the results of fMRU and DRS. Standardization of the fMRU protocol will increase the diagnostic relevance of information and in the future will make fMRU the only necessary study to determine management tactics for patients with UPJO.

Point-of-Care Ultrasound Diagnosis of Ureteropelvic Junction Obstruction in a Child With Recurrent Abdominal Pain and Vomiting

A case is described of a 4 year-old girl who presented with chronic episodic abdominal pain with vomiting. Physical examination was unremarkable aside from hypertension. Point-of-care renal ultrasound showed hydronephrosis, leading to a diagnosis of ureteropelvic junction obstruction presenting with Dietl crisis (episodic abdominal pain secondary to urinary tract obstruction). The clinical utility of point-of-care renal ultrasound in the evaluation of abdominal pain and ultrasound findings of ureteropelvic junction obstruction are highlighted.

Outcomes of robot-assisted transperitoneal pyeloplasty: Case series

Aim: Ureteral pelvic junction (UPJ) obstruction, which restricts the passage of urine from the pelvis to the ureter may cause progressive destruction of the kidney if left untreated. Causes of UPJ obstruction include various intrinsic and extrinsic factors. Symptomatic UPJ obstruction should be treated without delay. We herein aimed to present the results of robot-assisted pyeloplasty (RAP) that we performed in our clinic.Methods: Data of 15 patients who underwent RAP between January 2017 and 2019 in our clinic were examined. The diagnosis of ureteropelvic junction obstruction (UPJO) was based on intravenous pyelography (IVP), and diuresis renography (DTPA) was performed during follow-up. Dismembered pyeloplasty was performed on all patients with the DaVinci XI 4-arm robotic system. The results were retrospectively evaluated. Results: The mean age of all patients was 41.3 (8.2) years. There were 7 males and 8 females. None of the cases had previously undergone pyeloplasty. While 6 of the patients had intrinsic obstruction, 9 had extrinsic obstruction associated with aberrant vascular compression. The mean operation time and duration of anastomosis were 155.3 (29.8) and 33.4 (8.1) minutes, respectively. The mean amount of intraoperative bleeding was 48 (10.2) ml. The mean hospital stay was found as 3.6 (1.1) days. There was no conversion to open surgery in any of the patients. None of the patients had intraoperative or postoperative complications. The mean follow-up time was 12.7 (5.4) months. Postoperative IVP and DTPA of all the patients were found to have improved.Conclusion: RAP is a minimally invasive method with successful surgical and functional outcomes in the treatment of UPJO.

Urinary polyomavirus: novel biomarker of congenital ureteropelvic junction obstruction

Pregnancy is associated with reactivation and transmission of latent polyomavirus to fetus. Polyomavirus is also known to cause ureteral stenosis and hydronephrosis. The aim of this study was to investigate whether the urinary polyomavirus could be used as a potential biomarker in newborns with ureteropelvic junction obstruction (UPJO). Urinary polyomavirus virus was measured by PCR in 42 newborn infants with fetal hydronephrosis history. Random urine samples were obtained from newborns immediately after birth and from their mothers at the time of delivery. Results were compared with 25 healthy infants matched for gestational and postnatal ages. The diagnosis of UPJO was established by diuretic renal scintigraphy. UPJO was graded according to the Society for Fetal Urology (SFU) classification. The urine samples of healthy infants showed no detectable polyomavirus. No statistically significant difference was found in the median urinary polyomavirus level between grade 1 (1000 copies/mL) and grade 2 (1500 copies/mL) UPJO infants. When the median urinary BKV values were compared for each grade of UPJO, patients with grade 3 and 4 had significantly higher urinary polyomavirus levels than those with grades 1 or 2 (P<0.001). There was a strong correlation between the median polyomavirus in the urine of pregnant women and the urine of newborns with UPJO (P<0.001). Data suggest that routine screening of urinary polyomavirus may help to identify infants with severe obstruction in whom early surgical intervention could reduce the risk of developing progressive kidney disease. To the best of our knowledge this is the first prospective study to present the role of urinary polyomavirus in newborn infants with UPJO to distinguish between patients who would benefit from early surgical intervention. Urinary polyomavirus is a potential biomarker of UPJO in newborns with fetal hydronephrosis.

Stented versus stentless open pyeloplasty in children

Objective The aim of this study was to compare between stenting and nonstenting in dismembered pyeloplasty as regards outcome, early and late postoperative results, and complications. Background Ureteropelvic junction obstruction is a common congenital urologic anomaly. Open pyeloplasty is the standard surgical treatment. Drainage following pyeloplasty using a double J stent prevents subsequent stenosis and urine leakage. Patients and methods This study was conducted on 20 pediatric patients (maximum age 16 years) with a primary diagnosis of ureteropelvic junction obstruction who were divided into two groups: Group 1, the stented group double J (10 cases). Group 2, the nonstented group (10 cases). Classic Anderson–Hynes pyeloplasty was performed for the two groups. Results A total of 20 patients were included in the study. 16 (80%) cases were male and four (20%) cases were female. Their ages ranged from 6 months to 15 years. The mean ± SD age was 6.75 ± 4.53 years. All cases were unilateral; 10 (50%) cases were right sided and 10 (50%) cases were left sided. Postoperative complications included the following: urinary tract infection in only one case in group 1, residual mild hydronephrosis in only one case in group 1 and three (30%) cases in group 2; clot formation in only one case in group 2, and urinoma in only one case in group 2. Conclusion Pyeloplasty with a diverting stent is technically feasible and safe. Only risks for multiple anesthesias and economic burden with stent removal are present. The specific indication when stented pyeloplasty needs to be performed is in redo pyeloplasty, solitary kidney, inflamed renal pelvis, and hugely distended renal pelvis.

Comparison of the F+20 and F-15 Diuresis Technetium-99m Diethylenetriaminepentacetate Renography Protocols for Diagnosis of Ureteropelvic Junction Obstruction in Adult Patients with Hydronephrosis.

Introduction:Hydronephrosis (HDN) in adults is a common presentation and may be due to congenital ureteropelvic junction obstruction. Diuresis renography is the method of choice for differentiating a dilated unobstructed urinary system from a true obstruction. The aim of this study was to compare the F+20 protocol with F-15 protocol and see whether this new protocol can reduce inconclusive results.Materials and Methods:It was a prospective, comparative study included 51 adult patients of primary HDN. Each patient underwent both F+20 and F-15 diuretic Technetium-99m diethylenetriaminepentacetate (Tc-DTPA) renography protocol studies. The results of diuretic Tc-DTPA renography studied in terms of obstructive, nonobstructive, or equivocal.Results:A total 60 renal units (RU) with HDN were included in this study. The mean age of patients was 25.25 years. 36 RU presented with specific symptoms and 24 RU with vague symptoms or diagnosed incidentally. The equivocal results were significantly lower in F-15 protocol than F+20 protocol. The equivocal results in F+20 protocol were significantly higher with incidentally diagnosed HDN and patients presented with vague symptoms. Most of the equivocal results of F+20 protocol were converted into either obstructive or nonobstructive by the F-15 protocol.Conclusion:The F-15 diuretic renogram protocol was associated with significantly less equivocal results than F+20 protocol. Moreover, F-15 protocol allowed clarification in cases of equivocal results of F+20 protocol. Therefore, we suggest the F-15 diuresis protocol as a single test for confirmation or exclusion of obstruction especially in the adult patient of HDN presented with vague symptoms or diagnosed incidentally.

Pediatric laparoscopic pieloplasty

Introduction: Ureteropelvic junction obstruction (UPJO) is the most common congenital cause of upper urinary tract obstruction in children. Our objective is to report our experience concerning the first 20 laparoscopic pyeloplasties.&#x0D; Material and methods: Retrospective study including twenty children with diagnosis of UPJO that underwent laparoscopic pyeloplasty by a single surgeon, at our Hospital, between November 2010 and December 2014, with at least one year of follow-up. Success was defined as absence of conversion, resolution of symptoms and radiologic criteria improvement.&#x0D; Results: Median age at surgery was 9.5 years (range between 10 months and 17 years-old). Intrinsic obstruction was found in 7 cases, extrinsic obstruction in 12 cases and one case with both situations. Median operative time was 235 minutes (range between 165-275 minutes), with need for conversion in 2 cases (10%). Median hospital stay was 2 days (range between 2-5 days. Four patients (20%) had early postoperative complications and two cases (10%) needed surgical revision during follow-up. Median follow-up time was 33 months (range between 12-60 months). In follow-up, all but two patients were asymptomatic. There was radiologic improvement of hydronephrosis in all patients but one, although he had non-obstructive pattern in renographic drainage.&#x0D; Conclusion: Our results are similar to those found in literature, with success rates comparable to open pyeloplasty with advantages of minimally invasive surgery.

Acoustic radiation force impulse (ARFI) elastography in the evaluation of renal parenchymal stiffness in patients with ureteropelvic junction obstruction.

To investigate the role of acoustic radiation force impulse (ARFI) elastography in the detection of renal parenchymal damage in kidneys with and without ureteropelvic junction obstruction (UPJO). Twenty-five pediatric patients with a diagnosis of UPJO who underwent surgery and 15 pediatric patients with conservatively managed UPJO were prospectively evaluated with ARFI elastography. Sixteen healthy volunteers constituted the control group. Shear wave velocity (SWV) measurements in the upper, mid, and lower poles of the affected kidney were performed. SWV values of kidneys based on presence of UPJO and hydronephrosis grade were compared. The correlation of SWV values with residual renal function obtained from diethylenetriaminepentaacetic acid or mercaptoacetyltriglycine-3 renal scan was evaluated. Significantly, higher SWV values were found in control kidneys compared to kidneys affected by UPJO. The median SWVs were 2.82 (2.51-3.07) m/s for the control kidneys and 2.36 (2.09-2.53) m/s for the kidneys in the UPJO group (p<0.001). When UPJO patients were grouped according to the grade of hydronephrosis, grade 0 hydronephrotic kidneys [2.35 (2.11-2.50) m/s] and grade 3-4 hydronephrotic kidneys [1.86 (1.96-2.25) m/s] had significantly lower SWV values compared to grade 1-2 hydronephrotic kidneys [2.62 (2.37-2.90) m/s] (p<0.05). ARFI as a noninvasive, radiation-free procedure for evaluating parenchymal stiffness may prove useful in the diagnostic work-up and follow-up of children with UPJO-induced renal disease.

Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children.

Background:Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children.Objectives:The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO.Patients and Methods:This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup.Results:During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76%) proportion of UPJO in the boys and in the left side (78%). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3% whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO.Conclusions:Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO.

Association of angiotensin type 2 receptor gene polymorphisms with ureteropelvic junction obstruction in Brazilian patients.

The angiotensin type 2 (AT2 ) receptor takes part in the process of ureteric bud during kidney development. Therefore, the gene encoding AT2 receptor, the AGTR2 gene located in the X chromosome, is a potential candidate for genetic association with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). This study aimed to investigate whether AGTR2 gene polymorphisms are associated with CAKUT in general or even with common phenotypes of CAKUT in a Brazilian sample of paediatric patients. We analyzed 290 paediatric patients with CAKUT and 262 healthy controls from the same geographic area. TaqMan single-nucleotide polymorphism (SNP) genotyping assays for AGTR2 gene at rs1403543, rs3736556, rs35474657, rs5193 and rs5194 were performed. The sample was in Hardy-Weinberg Equilibrium for all five SNPs. The presence of CAKUT in general was not significantly associated with the SNPs included in this study. However, when patients were segregated according to major phenotypes, the diagnosis of Ureteropelvic Junction Obstruction (UPJO) was significantly associated with AGTR2 gene polymorphisms at rs3736556 and at rs5194. On the other hand, the diagnoses of vesicoureteral reflux and of multicystic dysplastic kidney were not associated with AGTR2 gene polymorphisms. Our results support that the AGTR2 gene may contribute to the pathogenesis of UPJO and the genetic origin of CAKUT could vary according to phenotype expression.

Diagnosis and treatment of ureteropelvic junction obstruction caused by renal crossing vessels:an analysis of 24 cases

To investigate the diagnosis, treatment and surgical outcomes of ureteropelvic junction obstruction (UPJO) caused by renal crossing vessels. The case records of 24 patients discharged from Peking University Third Hospital between June 2001 and September 2011 with the diagnosis of UPJO caused by renal crossing vessels were reviewed .Of the 24 patients, 17 were male and 7 were female patients. The mean age was 28 years (range, 2-63 years). The mean disease duration was 22.3 months (range, 7 days to 180 months). Of which, 4 patients underwent open surgery, and the other 20 patients were treated with laparoscopic surgery. Surgical approach was decided by operative conditions: adhesion release technique, dismembered pyeloplasty or Y-V anastomosisor, with or without cut off the crossing vessels. The kind of crossing vessels was recorded, and the effect of surgery was evaluated by follow-up. Fifteen cases were caused by oppressed renal crossing artery, 8 cases by renal crossing vein, and 1 case by 2 renal crossing arteries and 1 renal crossing vein. Among them, 11 cases were followed up successfully. Average follow-up time was 48.2 months (range, 13-120 months). Eight cases (8/11) were relieved, and 1 case (1/11) had no obvious improvement, another 2 cases (2/11) were aggravating. Among those 6 cases underwent adhesion release technique, 3 cases were relieved, 1 case had no obvious improvement, and 2 cases were aggravating. Five cases who underwent dismembered pyeloplasty was relieved significantly. Renal crossing artery is one of the main causes of UPJO, the crossing artery should be retained as far as possible. Crossing vessel oppression is not the only pathological cause of UPJO, so the treatment of UPJ constriction is also very important. Dismembered pyeloplasty seems to be the most efficacies treatment procedure for UPJO caused by repressed vessels, and the remission rate of adhesion release technique seems limited.

834 RENAL FUNCTION OUTCOMES FOLLOWING LAPAROENDOSCOPIC SINGLE-SITE (LESS) PYELOPLASTY

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013834 RENAL FUNCTION OUTCOMES FOLLOWING LAPAROENDOSCOPIC SINGLE-SITE (LESS) PYELOPLASTY Aditya Bagrodia, Brian Harrow, Ephrem Olweny, Stephen Faddegon, Jeffrey Cadeddu, and Jeffrey Gahan Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Brian HarrowBrian Harrow Dallas, TX More articles by this author , Ephrem OlwenyEphrem Olweny New Brunswick, NJ More articles by this author , Stephen FaddegonStephen Faddegon Dallas, TX More articles by this author , Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author , and Jeffrey GahanJeffrey Gahan Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Outcomes following laparoendoscopic single-site (LESS) pyeloplasty are limited to small cohorts with short-term follow up. The purpose of this study is to evaluate intermediate-term clinical and renal function outcomes of robotic LESS (R-LESS) and conventional LESS (C-LESS) pyeloplasty using diuretic renal scans and estimated glomerular filtration rate (eGFR). METHODS Consecutive patients presenting with ureteropelvic junction obstruction (UPJO) were evaluated by a single surgeon. Diagnosis of UPJO in each case was confirmed radiographically with abdominal computed tomography and diuretic renography. Radiographic obstruction (defined as T1/2 >20 min) was seen in 65% of patients at presentation. All patients who underwent robotic LESS (R-LESS) or conventional LESS (C-LESS) pyeloplasty were entered into a prospectively maintained database. Patient demographics, clinical, perioperative, and postoperative renal function outcomes were recorded. Double-J stents were removed after 4-6 weeks. Postoperative diuretic renography was performed approximately 6 weeks after stent removal, then at 6 months, and yearly thereafter. Clinical (symptomatic response) and radiographic outcomes were documented in each case. RESULTS Fifty-three patients underwent LESS pyeloplasty by a single surgeon from October 2007 to July 2012 (31 C-LESS: 22 R-LESS). Mean follow-up was 12.1 months. Mean operative time and mean blood loss were 202 minutes and 35 ml, respectively. Median hospital stay was 2.0 days. Conversion to open operations occurred in 4 LESS surgeries for failure to progress (7.8%). No intraoperative complications occurred. Postoperative complications occurred with 11 patients (21%). Of these, 9 were > Clavien Grade 3, 7 of which occurred in the C-LESS group. Symptomatic resolution was achieved in 49/51 cases (96.1%). Renal T½ improved in 95.5% of patients. Postoperative split renal function and eGFR improved in 89% and 79% of cases respectively, but were not statistically different from preoperative values. Diuretic renal scans performed at an average of 10.3 months following stent removal indicated radiographic resolution of obstruction (T1/2 ≤ 20 min) in 41/44 cases (93.2%) for the cohort. Paired differences in preoperative and postoperative T1/2 were statistically significant at p<0.01 for the overall cohort. CONCLUSIONS LESS pyeloplasty, when performed robotically or laparoscopically, is safe and efficacious. Both approaches provide excellent intermediate-term outcomes in terms of symptomatic relief and radiographic resolution of obstruction. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e342 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Brian Harrow Dallas, TX More articles by this author Ephrem Olweny New Brunswick, NJ More articles by this author Stephen Faddegon Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Jeffrey Gahan Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...