Pelvic Diameter Research Articles

The conundrum of high-grade hydronephrosis with non-obstructive drainage on diuretic renography

Patients with high grade hydronephrosis (HN) and non-obstructive drainage on mercaptoacetyltriglycine (MAG-3) diuretic renography (renal scans) can pose a dilemma for clinicians. Some patients may progress and require pyeloplasty; however, more clarity is needed on outcomes among these patients. Our primary objective was to predict which patients with high-grade HN and non-obstructive renal scan, (defined as T ½ time <20min) would experience resolution of HN. Our secondary objective was to determine predictors for surgical intervention. Patients with prenatally detected HN were prospectively enrolled from 7 centers from 2007 to 2022. Included patients had a renal scan with T ½<20min and Society for Fetal Urology (SFU) grade 3 or 4at last ultrasound (RBUS) prior to renal scan. Primary outcome was resolution of HN defined as SFU grade 1 and anterior posterior diameter of the renal pelvis (APD)<10mm on follow-up RBUS. Secondary outcome was pyeloplasty, comparing patients undergoing pyeloplasty with patients followed with serial imaging without resolution. Multivariable logistic regression was used for analysis. Of the total 2228 patients, 1311 had isolated HN, 338 patients had a renal scan and 129 met inclusion criteria. Median age at renal scan was 3.1 months, 77% were male and median follow-up was 35 months (IQR 20-49). We found that 22% (29/129) resolved, 42% of patients had pyeloplasty (54/129) and 36% had persistent HN that required follow-up (46/129). Univariate predictors of resolution were age≥3 months at time of renal scan (p=0.05), T ½ time≤5min (p=0.09), SFU grade 3 (p=0.0009), and APD<20mm (p=0.005). Upon multivariable analysis, SFU grade 3 (OR=4.14, 95% CI: 1.30-13.4, p=0.02) and APD<20mm (OR=6.62, 95% CI: 1.41-31.0, p=0.02) were significant predictors of resolution. In the analysis of decision for pyeloplasty, SFU grade 4 (OR=2.40, 95% CI: 1.01-5.71, p=0.04) and T ½ time on subsequent renal scan of ≥20min (OR=5.14, 95% CI: 1.54-17.1, p=0.008) were the significant predictors. Patients with high grade HN and reassuring renal scan can pose a significant challenge to clinical management. Our results help identify a specific candidate for observation with little risk for progression: the patient with SFU grade 3, APD under 20mm, T ½ of 5min or less who was 3 months or older at the time of renal scan. However, many patients may progress to surgery or do not fully resolve and require continued follow-up.

Clinical Outcomes and Prognostic Factors in Stage III C Cervical Cancer Patients Treated with Radical Radiotherapy or Radiochemotherapy.

Objective: Since the update of the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging criteria, there have been few reports on the prognosis of stage III C cervical cancer. Moreover, some studies have drawn controversial conclusions, necessitating further verification. This study aims to evaluate the clinical outcomes and determine the prognostic factors for stage III C cervical cancer patients treated with radical radiotherapy or radiochemotherapy. Methods: The data of 117 stage III C cervical cancer patients (98 III C1 and 19 III C2) who underwent radical radiotherapy or radiochemotherapy were retrospectively analyzed. We evaluated 3-year overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier method. Prognostic factors were analyzed using the Log-rank test and Cox proportional hazard regression model. The risk of para-aortic lymph node metastasis (LNM) in all patients was assessed through Chi-squared test and logistic regression analysis. Results: For stage III C1 and III C2 patients, the 3-year OS rates were 77.6% and 63.2% (P = .042), and the 3-year DFS rates were 70.4% and 47.4% (P = .003), respectively. The pretreatment location of pelvic LNM, histological type, and FIGO stage was associated with OS (P = .033, .003, .042, respectively); the number of pelvic LNM and FIGO stage were associated with DFS (P = .015, .003, respectively). The histological type was an independent prognostic indicator for OS, and the numbers of pelvic LNM and FIGO stage were independent prognostic indicators for DFS. Furthermore, a pelvic LNM largest short-axis diameter ≥ 1.5 cm and the presence of common iliac LNM were identified as high-risk factors influencing para-aortic LNM in stage III C patients (P = .046, .006, respectively). Conclusions: The results of this study validated the 2018 FIGO staging criteria for stage III C cervical cancer patients undergoing concurrent chemoradiotherapy. These findings may enhance our understanding of the updated staging criteria and contribute to better management of patients in stage III C.

Role of urinary N-acetyl-beta-D-glucosaminidase in predicting the prognosis of antenatal hydronephrosis.

Urinary biomarkers are known to be able to diagnose renal damage caused by obstruction at an early stage. We evaluated the usefulness of urine N-acetyl-beta-D-glucosaminidase (NAG) to determine the prognosis of antenatal hydronephrosis. From January 2019 to December 2021, a retrospective study was performed on patients with grade 3 or 4 hydronephrosis. We analyzed the ultrasonographic findings and the urinary NAG/Cr ratio between the laparoscopic pyeloplasty (LP) group and active surveillance (AS) group. A total of 21 children underwent LP for ureteropelvic junction (UPJ) obstruction and 14 children underwent AS. The mean age at the time of examination was 3.7 months (1.7-7.5 months) in the LP and 5.2 months (0.5-21.5 months) in the AS (p=0.564). The mean anteroposterior pelvic diameter was 30.0 mm (15.0-49.0 mm) in the LP and 16.7 mm (9.0-31.3 mm) in the AS (p=0.003). The mean renal parenchymal thickness was 2.6 mm (1.2-3.7 mm) in the LP and 3.8 mm (2.9-5.5 mm) in the AS (p=0.017). The urinary NAG/Cr ratio was 26.1 IU/g (9.8-47.4 IU/g) in the LP and 11.1 IU/g (2.6-18.1 IU/g) in the AS (p=0.003). After LP, the urinary NAG/Cr ratio was significantly reduced to 10.4 IU/g (3.4-14.2 IU/g) (p=0.023). The urinary NAG/Cr ratio, one of the biomarkers of acute renal injury, is closely related to the degree of hydronephrosis. Therefore, it may be useful to determine whether to perform surgery on the UPJ obstruction and to predict the prognosis.

Role of Diuretic Renography and Ultrasonography in Pelvic Ureteric Junction Obstruction among Infants: A Prospective Interventional Study

Introduction: Renography is a non invasive technique routinely used by clinicians to provide information about kidney structure and function. However, its role in the diagnosis of renovascular disease (especially in patients with renal insufficiency), the exclusion of obstruction, and during the follow-up of patients undergoing pyeloplasty is still controversial. Aim: To study the changes in Anteroposterior Pelvic Diameter (APD), cortical thickness, split renal function and T½ post pyeloplasty at three months and to determine the usefulness of these parameters in assessing successful pyeloplasty for Pelvic Ureteric Junction Obstruction (PUJO). Materials and Methods: This prospective non randomised interventional study was conducted in the Department of Nuclear Medicine, PGIMER, Chandigarh, India and Department of Paediatrics, JIPMER, Karaikal, Puducherry, India, from July 2020 to July 2021. A total of 31 infants with persistent postnatal Hydronephrosis (HDN) on Ultrasonography (USG) with no vesicoureteral reflux were included in the study and underwent 99mTc EC renography. The diagnosis of obstruction was determined by visual interpretation, renogram curves, Time to peak (Tmax), and Time from Tmax to T½max parameters. Patients with obstructed patterns in 99mTc EC renography underwent Anderson Hyne’s dismembered pyeloplasty. After three months of surgery, 99mTc EC renography and USG were performed on all enrolled patients. The Chi-square test was used for the comparison of the difference in proportion, and the Student’s t-test was used for the comparison of the mean difference, between two groups. Results: The mean age of enrolled infants was 5.79±3.36 months with a male preponderance (27 males and 4 females). Out of 31 infants, 23 (74%) showed an obstructive pattern of drainage on diuretic renogram and underwent Anderson-Hynes dismembered pyeloplasty. The observed difference in the preoperative renal USG anteroposterior diameter (27.85±14.3 mm) and parenchymal thickness (9.6±3.3 mm) vs postoperative anteroposterior diameter (8±3.19 mm) and parenchymal thickness (15.5±4.19 mm) was statistically significant (p-value=0.001). The follow-up renogram scan conducted at three months showed a significant reduction in clearance half-time (T½). However, there was no statistically significant variation in split renal function at three months after pyeloplasty. Conclusion: Both 99mTc EC renography and USG indicate the likelihood of successful pyeloplasty, and in settings with limited resources, USG may be a viable substitute for early follow-up after pyeloplasty.

Is Percentage Improvement in Anteroposterior Pelvic Diameter a Valuable Marker for Successful Drainage Postpyeloplasty in Isolated Pediatric Pelvi-ureteric Junction Obstruction.

Pelvic-ureteric junction obstruction (PUJO) causes urine stasis in the renal pelvis and progressive kidney damage. Postpyeloplasty improvement of renal function and urinary drainage is assessed by diuretic isotope renogram and ultrasonography. Renograms are expensive and have radiation exposure. This study explores whether ultrasound parameters such as percentage improvement in anteroposterior pelvic diameter (PI-APD) is a valuable markers for successful pediatric pyeloplasties. The aim of this study was to identify patients who would benefit from ultrasound monitoring of PI-APD alone instead of diuretic isotope renal scan for postoperative follow-up of pyeloplasty. This was a retrospective descriptive study. We analyzed 127 pediatric pyeloplasties performed and under follow-up between June 2016 and May 2021. We recorded the postoperative ultrasound and isotope renogram parameters. PI-APD (preoperative AP diameter - postoperative AP diameter)/preoperative AP diameter × 100) was compared with improvement in renogram parameters (differential renal function, Tmax, curve pattern, and retention) to look for a correlation between them. SPSS version 20.5, Chi-square and paired t-test were used for statistical analysis. About 73.2% of patients were males, with most cases detected antenatally (76.4%). The majority was left-sided PUJO (67.7%). The mean age at surgery was 30.8 months. We identified a statistically significant correlation between the ultrasound parameter PI-APD and the renogram parameter Tmax. There is no significant correlation between PI-APD and other renogram parameters. In patients whose ultrasound parameter PI-APD is >40% and renal parenchymal thickness has increased, isotope renograms can be avoided for follow-up of postpyeloplasty patients.

Single-port-plus-one robot-assisted laparoscopic modified Lich-Gregoir direct nipple ureteral extravesical reimplantation in children with a primary obstructive megaureter.

To introduce a new technique of single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation and ascertain its validity in the treatment of pediatric primary obstructive megaureter. Between January 2021 and November 2021, we retrospectively analyzed the clinical data of 12 children with primary obstructive megaureter who were admitted to the Department of Pediatric Surgery of Fujian Provincial Hospital. All 12 children were treated with single-port-plus-one robotic laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation. Five of them were female and seven were male, including nine cases were simple obstructive type, while the remaining three cases were obstructive with reflux type. The mean age of the children was 17.33 ± 6.99 (10-36) months and the mean follow-up time was 14.16 ± 1.75 (12-17) months. Changes in preoperative and first-year postoperative parameters were compared. The mean operative time for all 12 children was 123.58 ± 10.85 (110-145) min, with a mean internal operative time of 101.42 ± 0.85 (90-120) min, a mean operative bleeding time of 2.42 ± 0.67 (2-4) ml, and a mean hematuria duration of 16.08 ± 1.44 (14-19) h. The mean indwelling catheterization time was 2.25 ± 0.45 (2-3) days and the mean hospitalization time was 3.83 ± 0.39 (3-4) days. At the postoperative first year, the ureteral diameter, calyceal diameter, and anterior-posterior renal pelvic diameter were found to be significantly smaller than at the preoperative period (18.83 ± 3.21 mm vs. 6.83 ± 1.27 mm, 13.99 ± 3.58 mm vs. 3.5 ± 2.90 mm, and 34.92 ± 4.25 mm vs. 10.08 ± 1.88 mm, P < 0.001). There was a significant increase in renal cortical thickness and the percentage of differential renal function (3.63 ± 1.66 mm vs. 5.67 ± 1.88 mm, 33.75 ± 2.77 mm vs. 37.50 ± 1.31 mm, P < 0.001). The resolution rate of obstruction was 100% and no child developed DeNovo vesicoureteral reflux. The technique of modified Lich-Gregoir direct nipple ureteral extravesical reimplantation can help maintain the physiological direction of the ureter and at the same time enhance the effectiveness of antirefluxing in robotic surgery. The design of a single-port-plus-one wound can produce a cosmetic appearance by concentrating and hiding the wound around the umbilicus. This modified reimplantation procedure has the potential to become a promising technique in the robot-assisted treatment of primary obstructive megaureter.

Commentary to “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”

Commentary to “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”

Laparoscopic strategies in complex upper urinary tract obstruction

We enumerate the various laparoscopic strategies to resolve upper urinary tract (UUT) obstruction in the context of variations in anatomy and report their outcomes. Retrospective review of primary laparoscopic UUT reconstructions performed between May 2012 and May 2021. Anomalies included: malrotated kidney (MRK), horseshoe kidney (HSK), duplex kidney (DK), pure intrarenal pelvis (IRP) and mid-ureteric stenosis (MUS). Success was defined by postoperative resolution of symptoms, improvement of anterior-posterior renal pelvic diameter (APD) on US and drainage on Mag3. Complications were categorised by Clavien-Dindo grading. Outcomes compared using the student's t-test with P<0.05 considered statistically significant. Of the 214 laparoscopic primary UUT reconstructions, 37 (17.2%) were: 13-MRK, 12-HSK, 4-DK, 4-IRP and 4-MUS. Median age at surgery was 5-years (range 0.3-15). Dismembered pyeloplasty: 8; pyeloplasty with renal sinus dissection: 8; neo-PUJ anastomosis: 8; primary ureterocalycostomy: 7; pyeloureterostomy: 2; and uretero-ureterostomy: 4. Median follow-up was 43-months (range 8-108) with a success rate of 94.5% (35/37). Complete resolution of symptoms in 20/21 patients; improvement of hydronephrosis on US in 35/37 patients (median pre-operative APD 27mm vs. median postoperative APD 8mm) [P<0.001]; improvement of drainage on diuretic renogram in 32/34 kidneys and stable/improved DRF in 34/35 kidneys (median preoperative DRF - 45% vs. median postoperative DRF - 47%) [P>0.05]. Postoperative complications managed medically (II Clavien) included urinary tract infections - 2 patients (5%), stent-related symptoms in 2 (5%) and umbilical port site collection in 1 patient (3%). Recurrent pelvi-ureteric junction obstruction PUJO occurred in one patient (3%) requiring redo surgery (IIIb Clavien), renal stones in 1 (3%) which resolved with ESWL (IIIb Clavien); in 1 (3%) patient with a HSK there was complete loss of ipsilateral kidney function but this was managed conservatively up to date (I Clavien). Laparoscopic transperitoneal approach allows the prompt recognition of in-situ anatomical variants. UUT obstruction in such settings calls for a variety of strategies with excellent outcomes.

Internal Versus External Pelvimetry: A Validation Study With Clinical Implications

INTRODUCTION:Investigating the correlations between external pelvimetry variables and actual birth canal dimensions has important implications for clinical practice, especially for predicting dystocia. This validation study tests external and internal pelvimetry correlations.METHODS:This single-centered retrospective study included 142 women with records of computed tomography pelvimetry. The correlations between four internal variables (obstetric conjugate, transverse diameters of inlet, midplane, and outlet) and five external variables (intertrochanteric, inter anterosuperior iliac spines, external conjugate, transverse diagonal, and prepubic) were first studied individually. Then, the correlations between each internal variable and the seven external variables were jointly evaluated after adjusting for body mass index.RESULTS:As expected, the external conjugate correlated with the obstetric conjugate (r= .65;p&lt; .01) but only weakly with the transverse outlet (r= .21;p&lt; .05). In the simple correlation analysis, the intertrochanteric measure is also correlated with the transverse inlet (TRi), midplane (TRm), and outlet (TRo;r =.542–.672). The transverse diagonal measure marginally correlated with the TRi (r= .29;p&lt; .01). In the multiple regression models, the intertrochanteric measure is associated with the TRi, TRm, and TRo, while the transverse diagonal is associated with the TRi (B= .27;p= .01). The prepubic diameter was not a predictor of birth canal dimensions in either simple or multiple regression models.CONCLUSION:Our study confirms that the reduction of the birth canal in some dimensions (i.e., obstetric conjugate and transverse diameters) is predictable with external, accessible pelvic diameters (e.g., external conjugate, transverse diagonal, and intertrochanteric).

Ureteropelvic junction obstruction with polyps in children: clinical manifestations and supranormal preoperative differential renal function.

To describe and analyze the clinical manifestation and pre-DRF of UPJO children with polyps and explore the possible influencing factors of supranormal pre-DRF. All patients undergoing primary Anderson-Hynes pyeloplasty for UPJO due to polyp were retrospectively reviewed. Patients' characteristics, parameters of ultrasound and dynamic renograms (DR) were recorded in elaborate. Pre-DRF in groups of different age, weight, gender, pain, grade of hydronephrosis, anterio-posterior pelvic diameter (APD), length of kidney and postoperative ultrasonic parameters were compared. A total of 18 UPJO children with polyps were included. Five (27.78%) patients had SFU III grade of hydronephrosis. Seven (38.89%) patients were supranormal pre-DRF. All patients had pre-DRF > 40%. Drainage curve was delayed excretion in 12 (66.67%) patients and T1/2 < 20min was in 4 (22.22%) patients. Among the 16 patients who underwent preoperative IVP examination, 15 (93.75%) patients had concentration of intrarenal pelvis contrast agent within 10min. No significant difference in post-APD reduction rate and post-minPT increased was found between supranormal pre-DRF and non-supranormal pre-DRF groups. The supranormal pre-DRF was more likely to occur in young and low-weight children. The preoperative renal function of UPJO patients with polyps was well preserved, and 38.89% of them had supranormal pre-DRF. Patients with supranormal pre-DRF can be managed with the same strategies as those with normal renal function.

Mathematical modelling of peripheral haemodynamics of the shin in volleyball players of mesomorphic somatotype

Statistical modelling of peripheral haemodynamics indicators, which is conducted based on determining anthropometric and somatotypic features of the organism, can be considered a new way of personalising instrumental diagnostic examination. Therefore, determining the suitable rheovasographic parameters of the shin in highly skilled volleyball players of a particular somatotype is relevant. The purpose of this study was to investigate the total influence of indicators of the external structure of the body on the value of indicators reflecting the specific features of blood circulation in the shin in volleyball players of mesomorphic somatotype. A comprehensive clinical and laboratory study of the state of health and physical development of 108 volleyball players aged 16-20 years was conducted. The method of tetrapolar rheography with the use of a diagnostic computer multifunctional apparatus was used to determine the rheovasographic parameters of the shin, amplitude, time, and indicators of the ratio of amplitude and time rheovasographic parameters were evaluated. An anthropometric study of total and partial body measurements was carried out. Somatotyping was performed using the Heath-Carter method. The study selected 28 volleyball players of mesomorphic somatotype. Statistical models were created using direct stepwise multivariate regression analysis. For all amplitude and time rheovasographic parameters of the hip in volleyball players of mesomorphic somatotype, statistical models with high accuracy of description of signs were built. The 10 models included 94 anthropometric dimensions. The key determinants of shin blood circulation parameters are body circumference (most often forearm, neck, and shin circumference), chest and pelvic diameters, thickness of skin and fat folds (most often on the shin, abdomen, flank), and width of the epiphyses of long tubular bones. It was found that the indicators of external body structure within 63.84- 99.99% determine the value of indicators of regional blood circulation on the shin in volleyball players of mesomorphic somatotype. Statistical modelling makes it possible to determine the proper values of individual rheovasographic indicators on the shin depending on the anthropometric parameters of individuals of a certain gender, age, somatotype, which is especially significant for athletes of a certain sport, since their cardiovascular system indicators are greatly influenced by the specifics of sports activity

Diagnostic value of diuretic ultrasound in evaluating the need for reoperation in children undergoing pyeloplasty

BackgroundPyeloplasty currently stands as the standard treatment for UPJO. Our study aimed to assess the diagnostic value of sonographic parameters following Lasix administration in patients who underwent pyeloplasty to predict the recurrence of obstruction and the need for reoperation.MethodsThe study included 70 children with UPJO who underwent pyeloplasty. Renal ultrasound was performed on patients three to six months after pyeloplasty. Following the Lasix administration, the changes in ultrasound parameters at the 18th and 30th minute were documented. Within two weeks, patients underwent radioisotope renography. Diuretic ultrasound's diagnostic value in predicting the need for reoperation was assessed through a comparison with radioisotope renography.ResultsThe average age of the patients was 3.94 ± 3.52 years. Anteroposterior diameter of the renal pelvis (APD) changes at 18 and 30 min, and the average APD after surgery at 18 and 30 min was significantly higher in patients requiring reoperation. The best cutoff point of APD changes in the 18th minute was 9.50 (sensitivity = 91.7%, specificity = 82.8%). The best cutoff point of APD after surgery in the 18th minute was 25.90 (sensitivity = 91.7%, specificity = 81.0%). The best cutoff points of the resistive index (RI) in the 18th and 30th minutes were reported as 0.70 (sensitivity = 41.7%, specificity = 50.0%) and 0.71 (sensitivity = 41.7%, specificity = 37.9%), respectively.ConclusionsThe assessment of ultrasound findings following pyeloplasty has revealed that changes in APD can serve as a reliable means for assessing the efficacy of the operation.

Scinтigraphy in Children with Urinary Tract Dilatation (Antenatally Detected Hydronephrosis)

The causes of Antenatal Hydronephrosis/Urinary Tract Dilatation (ANH/UTD) vary from transient benign conditions-transit hydronephrosis, (resolves by birth or during infancy) to conditions that can significantly affect renal function. The outcome of depends on the underlying etiology, so it is very important to determine these causes. The definition and grading of ANH is based on the Anteroposterior Pelvic Diameter (APD) of the fetal renal pelvis. Antenatal management includes antenatal ultrasound monitoring, which is usually repeated every 4-6 weeks. It is recommended that the assessment of the severity of postnatal hydronephrosis is based on the APD of the renal pelvis. Extensive postnatal investigation was proposed to be limited to those with moderate or severe dilatation. Voiding cystourethrography and scintigraphy are usually preserved for children with postnatal APD &lt;15 mm and/or abnormal kidney parenchyma, severe caliyx dilatation ureteral dilatation and bladder pathology. Diuretic renal scintigraphy is important in the postnatal evaluation of infants with ANH, particularly in distinguishing kidneys with poor drainage from nonobstructive hydronephrosis with good drainage. According to our diuretic renography results, we conclude that in the presence of partial or no drainage, the separate renal function may not be significantly impaired. The finding of poor renal emptying is significantly more common among children with increasing renal pelvis APD. Technetium 99m-dimercaptosuccinic acid renal scintigraphy (99mTc-DMSA) has been used in renal imaging to estimate the functional renal mass (damage to the kidney) and relative renal function, especially in pediatric patients. A statistically significant correlation between the degree of hydronephrosis (APD) and DMSA scan finding and between the degree of the VUR and DMSA scan finding was established. Other than VUR, CAKUT (pelvic ureteric junction obstruction, pyelon et ureter duplex, megaureter, posterior urethra valves) were not statistically correlated with pathological findings on the DMSA scan.

The Utility of Mid-Pelvic Dimensions Via Plain Radiography in Predicting Cesarean Delivery

Introduction: Studies on the role of pelvimetry in predicting the mode of delivery have yielded mixed results. The aim of this study is to determine utility of the mid-pelvic measurement in predicting the mode of delivery in a cohort of women attempting vaginal delivery.&#x0D; Study Design and Methods: With this prospective cohort study, we evaluated the use of x-ray in predicting the delivery outcome of women attempting to deliver vaginally. Women were recruited before labor at &gt;36 weeks gestational age and X-ray pelvimetry was performed after delivery. The exposures of interest were mid pelvic measures including anteroposterior diameters, transverse diameters and circumferences. The outcome measures were whether the women delivered via vaginal route or had cesarean delivery. We estimated the distribution and calculated measures of central tendency and spread of each pelvic dimension. Area under the receiver-operating characteristics curve (AUC) was used to estimate the overall predictive ability for each pelvic dimension and the optimal cut-point was estimated using the method of Liu. Logistic regression analysis was used to identify independent predictors for mode of delivery. The Hosmer – Lemeshow goodness-of-fit test was used to estimate the overall fit while the AUC was used to estimate the overall prediction of the final model.&#x0D; Results: A total of 426 women met the inclusion criteria. The mean gestational age at delivery was 40 (±6.0) weeks and the majority were black parturient (62.6%0. A slight majority were nulliparous (52.1%). In all, 127 women (29.8%) were delivered by cesarean delivery. All the pelvic inlet and mid pelvic dimensions were approximately normally distributed. The AUC ranged from 0.62 to 0.86. While the pelvic inlet and mid pelvic diameters had equivalent AUC, the optimal cut-point of the mid pelvic anteroposterior diameter (10.8cm) had both higher sensitivity and specificity than the pelvic inlet anteroposterior diameter (10.2cm) (95% and 85% versus 90% and 80%, respectively). There was an inverse relationship between the mid pelvic anteroposterior diameter and mode of delivery by cesarean section, with a 100% risk among women with a diameter of 9cm or less. However, the multivariable model developed had an AUC of 0.90, indicating overall good and higher predictive ability than the mid-pelvic anteroposterior diameter alone.&#x0D; Conclusions: In this large cohort study, the mid pelvic anteroposterior diameter best predicted mode of delivery by cesarean section.

Laparoscopic assisted dismembered pyeloplasty versus open pyeloplasty in UPJO with poorly function kidney in pediatrics

BackgroundThe management of UPJO with poor function kidney, less than 10%, has been the subject of debate for more than a decade. Some authors have recommended nephrectomy, while others favor renal salvage (pyeloplasty). We report our experience with laparoscopic assisted pyeloplasty in pediatric patients with poorly functioning kidneys in comparison with an open approach.Materials and methodsA retrospective study was conducted to review 65 patients who were diagnosed with hydronephrosis and had impaired renal function due to UPJO. The study was conducted in the pediatric surgery departments of Al-Azhar University Hospital and Fattouma Bourguiba University Hospital of Monastir over a period of 20 years. Limited to pediatric patients with UPJO with ≥ Grade III hydronephrosis, antero-posterior pelvic diameter ≥ 20 mm, as well as a renal function equal to or less than 10%, was corrected by laparoscopic assisted or open pyeloplasty.ResultsThere were 40 cases in group A who underwent laparoscopic assisted pyeloplasty, and 25 cases in group B who underwent open pyeloplasty. There were no complications or difficulties during the operation. The mean operative time in group A was 90 ± 12 min, while in group B, it was 120 ± 11 min. The renal assessment parameters significantly improved in both groups. In group A, the mean split renal function was 7.9 ± 1.3% and increased to 22.2 ± 6.3%. In group B, the mean split renal function was 8.1 ± 1.1% and increased to 24.2 ± 5.1%. However, the differences between both groups in terms of pre-operative and post-operative renal functions were statistically insignificant.ConclusionLaparoscopic assisted pyeloplasty is an effective treatment for patients with poorly functioning kidneys, especially those with less than 10% function. While this surgical procedure requires shorter operative times, it yields functional outcomes that are comparable to open approach.

Risk factors for adverse outcomes after pediatric pyeloplasty: A retrospective cohort study.

To identify the risk factors for adverse outcomes after pediatric pyeloplasty. We conducted a retrospective review of all children under the age of 14 years who underwent primary pyeloplasty for unilateral ureteropelvic junction (UPJ) obstruction at a single teaching hospital in Tunisia between January 1, 2013, and December 31, 2022. A total of 103 patients were included. Median age of patients at surgery was 27 months (interquartile range [IQR], 13-44). On ultrasound, median renal pelvic anteroposterior diameter was 3.2 cm (IQR, 2.3-4), and the median renal cortex thickness (RCT) was 2.5 mm (IQR, 2-3.5). Median differential renal function (DRF) on preoperative radionuclide renal scan was 40% (IQR, 30-46). Postoperative adverse outcomes occurred in 28 patients (27.2%). These included 19 cases of urinary tract infections (UTIs), 11 cases of UPJ restenosis, four cases of UPJ leakage, two cases of urinoma, and two cases of diversion-related complications. Multivariate logistic regression analysis revealed two factors significantly and independently related to postoperative negative outcomes: RCT <3 mm and DRF > 50%. Our study demonstrated that preoperative RCT on ultrasound of less than 3 mm and preoperative DRF on radionuclide renal scan of more than 50% were independent risk factors for adverse outcomes following pediatric pyeloplasty. These factors could be of interest in identifying, early on, patients who will develop postoperative negative outcomes, giving them more attention and support, and explaining the prognosis to the patient and family.

Lymph node size detected by magnetic resonance imaging for prediction of lymph node involvement in locally advanced cervical cancer.

To investigate lymph node (LN) size detected by Magnetic Resonance Imaging (MRI) for prediction of LN involvement in locally advanced cervical cancer (LACC). A total of 55 cases diagnosed with LACC (IIB-IVA FIGO 2018) between 28 December 2010 and 30 October 2020 were evaluated in this retrospective study. LN involvement was evaluated in patients who underwent surgical staging and MRI. The prediction of LN involvement based on LN size on MRI was calculated statistically. The mean age of 55 patients was 56 (33-78) years. For the cases, 76.4% were stage IIB, 12.7% were stage III, and 10.9% were stage IVA. Squamous cell histological type was detected with a rate of 90.9%. The cut-off value for pelvic LN diameter on MRI in predicting pelvic LN involvement was 18.5 mm, and the sensitivity and specificity values were calculated as 50.0% and 93.6%, respectively (p=0.027). The cut-off value for pelvic and para-aortic LN diameter on MRI in predicting pelvic and para-aortic LN involvement was 17.0 mm with a sensitivity of 41.7% and specificity of 88.4% (p=0.081). In LACC, prediction of LN involvement by LN diameter detected on MRI has moderate sensitivity and high specificity with a cut-off value of 17.0 mm.

Determination of tissue tracer transit of Technetium-99m-mercaptoacetyltriglycine diuretic renography in infants with suspected ureteropelvic junction obstruction - A multicenter prospective observational study

There is an ongoing controversy regarding management of ureteropelvic junction obstruction in infants, with a shift towards a non-operative approach. However, precise predictors of outcome are lacking. Recent studies postulated a high prognostic value of Technetium-99m-mercaptoacetyltriglycine tissue tracer transit with regard to the development of an impaired differential renal function and its potential improvement following pyeloplasty. To evaluate the prognostic value of Technetium-99m-mercaptoacetyltriglycine tissue tracer transit for the occurrence of changes in differential renal function in infants with suspected unilateral ureteropelvic junction obstruction in a prospective observational multicenter study. Infants below 3 months of age with a unilateral isolated hydronephrosis≥grade 3 received ultrasound and Technetium-99m-mercaptoacetyltriglycine diuretic renography at two different time points (timepoint 1 and timepoint 2). Data were analyzed at local centers and at the study center and were collected in an internet-based database system. Tissue tracer transit was determined for each diuretic renography, inter-observer variation for tissue tracer transit and standard parameters for judgement of differential renal function development were assessed. Thirty-seven patients were analyzed. Median age was 11 weeks (7-15) at timepoint 1 and 26 weeks (19-33) at timepoint 2. A delayed tissue tracer transit at timepoint 1 was not associated with deterioration of differential renal function at timepoint 2 in both, locally (10/37 cases) and centrally (4/37) analyzed cases. However, sensitivity and specificity were poor. The intraclass correlation coefficient comparing local and central findings of tissue tracer transit and renal drainage demonstrated poor or fair agreement. Analysis of standard parameters for differential renal function development revealed a prognostic value only for the dichotomized anteroposterior renal pelvic diameter (APD, p=0.03, 95%-CI 1.2-22.2). Regarding the primary endpoint of our study, we could not confirm the hypothesis that delayed tissue tracer transit reliably predicts a subsequent decline in differential renal function in the cohort of patients studied. Whether the low age of the patients, technical problems in the correct assessment of tissue tracer transit by the investigator in early infancy, the study design, or the parameter itself played a role is debated. In the presented setting tissue tracer transit was not useful as a predictive parameter for deterioration of differential renal function in infants with suspected unilateral ureteropelvic junction obstruction. Sensitivity and specificity of tissue tracer transit were not sufficient for risk stratification. Improved utility of tissue tracer transit as a marker might be achieved using a different study setting.

Radiographic Pelvimetry in Relation to Dystocia in Bulldogs

Abstract Dystocia is a common complication of parturition in the breed of English Bulldogs, where most females are not able to have a natural parturition and many litters are delivered by caesarean section. The aim of this study was to evaluate the diameter of the pelvis of 11 females of English Bulldogs through radiographic pelvimetry and do proper measurements to observe if there are any correlations between a narrow pelvic canal and dystocia detected in the breed. The external parameters were also assessed to look for any differences between weight, height, and length in relation to the dystocia in the breed. The mean weight of the dogs with natural parturition was 21.25 ± 0.91 kg, whereas the females which had undergone caesarean section was 25.16 ± 1.44 kg (P = 0.0004). A P-value shows strong evidence for the hypothesis of this study as a possible factor of dystocia of the breed. The values of height and length in the category of dams which had undergone natural parturition were in cm 44.8 ± 2.48 (length) and 36.1 ± 0.98 (height). In the category of dogs which had undergone caesarean section, the parameters were in cm 45.4 ± 2.60 and 36.0 ± 1.58, respectively. The P-value for length were 0.72 for length and P-value for height were 0.83. Difference between the diameter of the pelvis in the two groups of English Bulldog females was P = 0.12, so there is no significant evidence. However, it could be significant for a possible future study with a higher number of animals for measuring pelvic diameter.

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.