Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2016; 26(01): 15-21
DOI: 10.4103/0971-3026.178282
Abdomen

Is decreased diameter of renal pelvis in prone position an indicator of successful pyeloplasty?

Gyanendra Sharma
Department of Urology, Chitale Clinic Private Limited, Solapur, Maharashtra, India
,
Anshu Sharma
Department of Radio-Diagnosis, Chitale Clinic Private Limited, Solapur, Maharashtra, India
,
Vivian Yee-Fong Leung
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
,
Winnie Chiu-Wing Chu
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
› Author Affiliations
› Further Information
Also available at
  PDF Download Permissions and Reprints

Abstract

Objective: To evaluate patients who had undergone pyeloplasty for pelviureteric junction obstruction, by measuring the anteroposterior diameter (APD) of the renal pelvis in supine and prone positions, and determine whether a decrease in APD in prone position can exclude obstruction in dilated renal system. Materials and Methods: From January 2012 to December 2013, patients who had undergone pyeloplasty were evaluated by ultrasound in two centers. The difference of APD of the renal pelvis in supine and prone positions was obtained. Correlation was made with the pre- and post-pyeloplasty renal function by radionuclide renogram. Results: There were 42 patients (31 males, 11 females; age range 5 months to 18 years). Residual hydronephrosis was detected in 41 patients of whom 35 patients (85%) showed decrease in APD by >10% in prone position. These patients and the one without hydronephrosis showed either no deterioration or improvement in renal function. Six patients (15%) showed either no change or increase in APD in prone position. Three patients (7.5%) were confirmed to have decrease in renal function indicating obstruction. Three patients (7.5%) showed no deterioration of renal function, but sluggish drainage on radionuclide renogram. Conclusion: Demonstration of decreased APD of renal pelvis in prone position by ultrasound is useful to differentiate obstructed from non-obstructed dilated renal system, and it correctly identified 85% candidates with successful pyeloplasty. In patients with no decrease or increase in APD at prone position, further follow-up is recommended to rule out obstruction.

Keywords

Hydronephrosis - pelvi ureteric junction obstruction - pyeloplasty - ultrasonography


Publication History

Article published online:
30 July 2021

© 2016. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Capello SA, Kogan BA, Giorgi LJ Jr, Kaufman RP Jr. Prenatal ultrasound has led to earlier detection and repair of ureteropelvic junction obstruction. J Urol 2005;174:1425-8.
  • 2 Seixas-Mikelus SA, Jenkins LC, Williot P, Greenfield SP. Pediatric pyeloplasty: Comparison of literature meta-analysis of laparoscopic and open techniques with open surgery at a single institution. J Urol 2009;182:2428-32.
  • 3 Romao RL, Farhat WA, Pippi Salle JL, Braga LH, Figueroa V, Bägli DJ, et al. Early Post operative Ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction. J Urol 2012;188:2347-53.
  • 4 Babu R, Sai V. Pelvis/cortex ratio: An early marker of success following pyeloplasty in children. J Pediatr Urol 2010;6:473-6.
  • 5 McAleer IM, Kaplan GW. Renal function before and after pyeloplasty: Does it improve? J Urol 1999;162:1041-4.
  • 6 Conford PA, Rickwood AM. Functional results of pyeloplasty in patients with ante-natally diagnosed pelvi-ureteric junction obstruction. Br J Urol 1998;81:152-5.
  • 7 Chertin B, Rolle U, Farkas A, Puri P. Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi-ureteric junction obstruction? BJU Int 2002;90:72-5.
  • 8 Castagnetti M, Novara G, Beniamin F, Vezzú B, Rigamonti W, Artibani W. Scintigraphic renal function after unilateral pyeloplasty in children: A systematic review. BJU Int 2008;102:862-8.
  • 9 Park K, Baek M, Cho SY, Choi H. Time course of hydronephrotic changes following unilateral pyeloplasty. J Pediatr Urol 2013;9:779-83.
  • 10 van den Hoek J, de Jong A, Scheepe J, van der Toorn F, Wolffenbuttel K. Prolonged follow-up after paediatric pyeloplasty: Are repeat scans necessary? BJU Int 2007;100:1150-2.
  • 11 Chertin B, PollackA, Koulikov D, Rabinowitz R, Shen O, Hain D, et al. Does renal function remain stable after puberty in children with prenatal hydronephrosis and improved renal function after pyeloplasty? J Urol 2009;182(Suppl):1845-8.
  • 12 Amling CL, O′Hara SM, Wiener JS, Schaeffer CS, King LR. Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: Long term outcome in 47 renal units. J Urol 1996;156:2020-4.
  • 13 Cost NG, Prieto JC, Wilcox DT. Screening ultrasound in follow-up after pediatric pyeloplasty. Urology 2010;76:175-9.
  • 14 Neste MG, du Cret RP, Finlay DE, Sane S, Gonzalez R, Boudreau RJ, et al. Postoperative diuresis renography and ultrasound in patients undergoing pyeloplasty. Clin Nucl Med 1993;18:872-6.
  • 15 Kis E, Verebély T, Kövi R, Máttyus I. The role of ultrasound in the follow-up of postoperative changes after pyeloplasty. Pediatr Radiol 1998;28:247-9.
  • 16 Almodhen F, Jednak R, Capolicchio JP, Eassa W, Brzezinski A, El-Sherbiny M. Is routine renography requires after pyeloplasty. J Urol 2010;184:1128-33.
  • 17 Onen A. An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis. J Pediatr Urol 2007;3:200-5.
  • 18 Imaji R, Dewan PA. Calyx to parenchyma ratio in pelvi-ureteric junction obstruction. BJU Int 2002;89:73-7.
  • 19 Cost GA, Merguerian PA, Cheerasarn SP, Shortliffe LM. Sonographic renal parenchymal and pelvicaliceal area: New quantitative parameters for renal sonographic follow-up. J Urol 1996;156:725-9.
  • 20 Patti G, Menghini ML, Todini AR, Marrocco G, Calisti A. The role of the renal resistive index ratio in diagnosing obstruction and in the follow-up of children with unilateral obstruction. BJU Int 2000;85:308-12.
  • 21 Brkljacić B, Kuzmić AC, Dmitrović R, Rados M, Vidjak V. Doppler sonographic renal resistance index and resistance index ratio in children and adolescents with unilateral hydronephrosis. Eur Radiol 2002;12:2747-51.
  • 22 Egan SC, Stock JA, Hanna MK. Renal ultrasound changes after internal double-J stented pyeloplasty for ureteropelvic junction obstruction. Tech Urol 2001;7:276-80.
  • 23 Sharma G, Sharma A, Maheshwari P. Predictive value of decreased renal pelvis anteroposterior diameter in prone position for prenatally detected hydronephrosis. J Urol 2012;187:1839-43.
  • 24 Friedenberg RM, Harris RD. Excretory urography in the adult. In: Pollack HM, McClennan BL, Kenney PJ, Dyer R, editors. Clinical Urography. 2 nd ed. Philadelphia: WB Saunders; 2000. p. 147-257.
  • 25 Carrico CW, Zerin JM. Sonographic measurement of renal length in children: Does the position of the patient matter? Pediatr Radiol 1996;26:553-5.
  • 26 Berdon WE, Baker DH, Leonidas J. Advantages of prone positioning in gastrointestinal and genitourinary roentgenologic studies in infants and children. Am J Roentgenol Radium Ther Nucl Med 1968;103:444-55.
  • 27 Lantz AG, Ordon M, Pace KT, Honey RJ. Prone versus supine lasix renal scan to assess surgical success after laparoscopic and robot-assisted pyeloplasty. J Endourol 2013;27:1431-4.