Percent improvement in renal pelvis antero-posterior diameter (PI-APD): Prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone

Rickard, Mandy; Braga, Luis H.; Oliveria, John Paul; Romao, Rodrigo; DeMaria, Jorge; Lorenzo, Armando J.

doi:10.1016/j.jpurol.2016.04.003

Cited by 35 publications

(17 citation statements)

References 16 publications

(20 reference statements)

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“…11,12 It has been suggested that ultrasound could be the sole initial method to be used at follow-up and that renal scan may be reserved for selected cases. 4,6,13 Several sonographic parameters for the evaluation of obstruction after pyeloplasty have been reviewed. 6 The grade of hydronephrosis at follow-up is a morphological parameter that may not identify relevant obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…6 The grade of hydronephrosis at follow-up is a morphological parameter that may not identify relevant obstruction. 4 Consequentially, several authors focused on an objective and quantifiable sonographic measure for relevant obstruction. 4,5,14 In several studies, the difference of APD postversus preoperative has been suggested to be of most value.…”

Section: Discussionmentioning

confidence: 99%

“…4 Consequentially, several authors focused on an objective and quantifiable sonographic measure for relevant obstruction. 4,5,14 In several studies, the difference of APD postversus preoperative has been suggested to be of most value. 6,7 Romao et al postulated that the change in the APD may indicate which patients require closer follow-up monitoring and may help identify patients at risk for reintervention.…”

Section: Discussionmentioning

confidence: 99%

“…recently advocated that ultrasound could replace renal scan in the follow-up of children after pyeloplasty. 2,4,5 A measurement that has proven to be of most value is the anteroposterior diameter (APD) of the renal pelvis. 6,7 The APD was postulated to be indicative of sufficient pelvic drainage during early follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 The APD was postulated to be indicative of sufficient pelvic drainage during early follow-up. 4,5 A cause of potential bias, however, is the fact that pyeloplasty nowadays is performed with varying degrees of renal pelvis reduction. This may impact the interpretation of the postoperative result.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Monitoring after Pelvis-Sparing Dismembered Pyeloplasty: High Sensitivity and Low Specificity for the Success of Operation

et al. 2019

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Introduction A decrease in the anteroposterior diameter (APD) of the renal pelvis on ultrasound has been postulated to be indicative of sufficient pelvic drainage after pyeloplasty. Traditionally, pyeloplasty is combined with a reduction of the renal pelvis. We have recently demonstrated that resection of the pelvis during pyeloplasty is not necessary. We aimed to evaluate the efficacy of ultrasound APD measurements during follow-up to identify sufficient pelvic drainage in these patients. Materials and Methods Data from children (0–16 years) who underwent pelvis-sparing pyeloplasty in our institution from 2007 to 2018 were analyzed retrospectively. We included only those patients for whom pre- and postoperative ultrasound and renal scan data were available. Patients with a decrease versus patients with an increase in APD were analyzed with regard to urinary drainage and reoperation. Results Seventy-three patients who underwent follow-up at a mean of 3 months after operation were included; 61 showed a decrease in APD. Renal scan showed sufficient urinary drainage in 58 of them, with none requiring reoperation. Twelve patients had an increase in APD. Six of these showed free urinary drainage on renal scan; another six showed insufficient drainage, of whom five required reoperation. The positive predictive value of a decrease in APD was 1, and the negative predictive value of increase in APD was 0.42. Conclusion To our knowledge, this is the first study evaluating the efficacy of ultrasound measurements to identify patients with decompensated urinary drainage during early follow-up after pyeloplasty with pelvis sparing. Post- versus preoperative decrease in renal pelvis diameter appears to be sufficient to rule out recurrence of obstruction. Renal scan seems to be indicated only in cases with post- versus preoperative increase in the APD of the renal pelvis on ultrasound.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound Monitoring after Pelvis-Sparing Dismembered Pyeloplasty: High Sensitivity and Low Specificity for the Success of Operation

et al. 2019

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Prenatal hydronephrosis: Bridging pre‐ and postnatal management

et al. 2022

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Urinary tract dilation (UTD), including hydronephrosis (HN) is the most common prenatally detected anomaly and affects up to 1%–2% of pregnancies. Postnatally, it resolves without surgical intervention in approximately 75%–80% of children, however this may take several years to occur, necessitating repeated clinic visits and additional invasive testing for many. For the remainder, a surgical intervention will be offered to relieve obstruction or to correct vesicoureteral reflux. During the monitoring period, many of these infants will be offered continuous antibiotic prophylaxis for the prevention of urinary tract infections, however this remains a controversial topic among pediatric urologists and nephrologists. Herein, we present an up‐to‐date review of the early management of prenatally detected UTD including timing of postnatal imaging, the use of antibiotics, when circumcision may be beneficial and long term outcomes of the most common HN etiologies. We also propose a decision making tool to help guide the care of infants with UTD.

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Endourologic Retrograde Balloon Dilatation of the Primary Ureteropelvic Junction Obstruction in Children

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Parente³

et al. 2022

Minimally Invasive Techniques in Pediatric Urology

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Percent improvement in renal pelvis antero-posterior diameter (PI-APD): Prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone

Cited by 35 publications

References 16 publications

Ultrasound Monitoring after Pelvis-Sparing Dismembered Pyeloplasty: High Sensitivity and Low Specificity for the Success of Operation

Ultrasound Monitoring after Pelvis-Sparing Dismembered Pyeloplasty: High Sensitivity and Low Specificity for the Success of Operation

Prenatal hydronephrosis: Bridging pre‐ and postnatal management

Endourologic Retrograde Balloon Dilatation of the Primary Ureteropelvic Junction Obstruction in Children

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