Equivocal Ureteropelvic Junction Obstruction on Diuretic Renogram—Should Minimally Invasive Pyeloplasty be Offered to Symptomatic Patients?

Özayar, Asım; Friedlander, Justin I.; Shakir, Nabeel; Gahan, Jeffrey; Cadeddu, Jeffrey A.; Morgan, Monica

doi:10.1016/j.juro.2014.10.100

Cited by 21 publications

(17 citation statements)

References 17 publications

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“…The estimated reporting of ‘equivocal results’ in most series is 15%. 7-9 In our series, 52% had equivocal T 1/2 which may be attributed to testing at various independent radiological centers outside of our tertiary referral institution. We found a wide range of nonstandard protocols being used at these centers to perform MAG3 renal scans and great divergence in the interpretation of results on radiographic reports.…”

Section: Commentmentioning

confidence: 59%

“…A second study from Ozayer et al reported mutual symptom relief in patients after pyeloplasty regardless of any evidence of obstruction on the preoperative renal scan. 7 In our cohort, a relatively high number of patients had a normal T1/2 that ultimately underwent pyeloplasty and achieved symptomatic relief. We confirmed the presence of UPJO with retrograde ureterograms for patients who had a compelling history for UPJO with a normal T 1/2 hprior to pyeloplasty.…”

Section: Commentmentioning

confidence: 82%

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Percent of Tracer Clearance at 40 Minutes in MAG3 Renal Scans Is More Sensitive Than T 1/2 for Symptomatic Ureteropelvic Junction Obstruction

Rundstedt

Scovell

Bian

et al. 2017

Urology

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Objective To increase the diagnostic sensitivity of standard MAG3 diuretic renal scans for ureteropelvic junction obstruction (UPJO) by exploring the utility of an alternative measurement P40, the percentage of maximal tracer counts present at 40 minutes. Methods Patients with strong clinical and anatomic evidence for UPJO may have a normal T1/2, making definitive diagnosis difficult. We reviewed the charts of 142 consecutive patients who underwent successful laparoscopic or robotic-assisted laparoscopic pyeloplasty for UPJO between 2005 and 2015. Both pre- and post-operative renal scan images were available for 37 symptomatic patients with primary unilateral UPJO and two kidneys. We defined P40 as the percentage of maximal tracer counts present at 40 minutes. We identified the upper limit of normal (97.5th percentile, +2SD) for P40 using the pre-operative renal scans from the unaffected kidney. We compared the sensitivity of P40 to T1/2 to identify symptomatic UPJO. Results In our cohort, 51% of symptomatic patients (n=19) had a normal T1/2 (Median 8.9 min; IQR: 7.5 min) and 49% (n=18) had an abnormal T1/2 (Median: 40 min; IQR: 0 min). No patients had an abnormal P40 on their unaffected kidney. All patients with an abnormal T1/2 also had an abnormal P40. P40 increased the sensitivity of the renal scan from 49% (n=18/37) to 73% (n=27/37) when compared to T1/2. The majority of patients (95%) demonstrated an improvement in P40 after pyeloplasty. Conclusion P40 markedly increases the sensitivity of a renal scan for diagnosing symptomatic UPJO and may be another valuable marker in addition to T1/2 to document functional improvement in drainage after pyeloplasty.

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Section: Commentmentioning

confidence: 59%

Section: Commentmentioning

confidence: 82%

Percent of Tracer Clearance at 40 Minutes in MAG3 Renal Scans Is More Sensitive Than T 1/2 for Symptomatic Ureteropelvic Junction Obstruction

Rundstedt

Scovell

Bian

et al. 2017

Urology

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“…Percutaneous nephrostomy was first described in 1955 by Goodwin et al for relief of an obstructed kidney and became a widely accepted procedure in children in the 1980s. 9,10,11,12 . Some reports in the 1980s described the use of PCN as an easy and safe procedure to determine the recoverability of renal function in obstructed kidneys (13) with a high technical success rate (88-99%) and a low complication rate (4-8%) (14,15) .…”

Section: Discussionmentioning

confidence: 99%

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Chowdhury¹,

Zaman²,

Rasul³

et al. 2020

Bang J Urology

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Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

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“…Cross-sectional abdominal imaging at the time of acute pain is critical for identifying hydronephrosis. While a renal scan is the gold standard to document functional obstruction, a recent study by Ozayar et al noted that almost all patients with a highly suggestive clinical picture but equivocal renal scan findings benefit from surgical correction [ 5 ]. In this case, the classic clinical history and definitive CT findings at the time of pain obviated the need for a renal scan.…”

Section: Discussionmentioning

confidence: 99%

Delayed Recognition of an Ureteropelvic Junction Obstruction in a Young Adult Female

Schulman

Wuilleumier

Teper

2015

Case Reports in Urology

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A percentage of ureteropelvic junction obstruction cases are clinically silent in childhood and manifest symptoms in adults. Herein we present a 25-year-old female with several years of intermittent flank pain and abdominal symptoms with prior inconclusive diagnostic workup including abdominal imaging without hydronephrosis. Ultimately, a CT scan performed during an acute pain crisis clearly identified right-sided hydronephrosis. The keys to diagnosis are awareness of this entity, a detailed history, and obtaining imaging studies during a crisis. The patient subsequently underwent a right robotic-assisted laparoscopic pyeloplasty with preservation of a lower pole crossing vessel. We highlight noteworthy features of the clinical presentation and surgical repair.

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Equivocal Ureteropelvic Junction Obstruction on Diuretic Renogram—Should Minimally Invasive Pyeloplasty be Offered to Symptomatic Patients?

Abstract: In patients with radiographic equivocal ureteropelvic junction obstruction and flank pain minimally invasive pyeloplasty efficaciously provides symptomatic relief and functional preservation. Results are comparable to those in patients with high grade obstruction.

Cited by 21 publications

References 17 publications

Percent of Tracer Clearance at 40 Minutes in MAG3 Renal Scans Is More Sensitive Than T 1/2 for Symptomatic Ureteropelvic Junction Obstruction

Percent of Tracer Clearance at 40 Minutes in MAG3 Renal Scans Is More Sensitive Than T 1/2 for Symptomatic Ureteropelvic Junction Obstruction

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Delayed Recognition of an Ureteropelvic Junction Obstruction in a Young Adult Female

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