Sonographic follow-up after pyeloplasty: a large, retrospective cohort analysis
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In brief
In brief
This retrospective study of 111 pediatric pyeloplasty cases demonstrates that antero-posterior diameter and pelvis/cortex ratio are reliable ultrasound markers for surgical success, with 85% symptom resolution by one year. Laparoscopic and open approaches showed equivalent outcomes, while early failure indicators include APD >3cm or <25% reduction and PCR >4.
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Abstract
Purpose
Routine scintigraphy after surgery for uretero-pelvic junction obstruction (UPJO) is discouraged, making ultrasound the preferred option for follow up. Yet, interpretation of sonographic parameters is rarely straightforward.
Methods
We reviewed 111 cases including 97 pyeloplasty (52 open, 45 laparoscopic) and 14 pyelopexy during a 7-year period. Pre- and postoperative pelvic antero-posterior diameter (APD), cortical thickness (CT) and pelvis/cortex ratio (PCR) was measured serially.
Results
85% were free of symptoms by 1 year. Only 11% had complete resolution of hydronephrosis. Eleven (10.4%) needed a redo procedure. Mean reduction in APD was 32.6%, 45.8%, and 51.7% at 6 weeks, 3 and 6 months respectively. CT increased by an average 55.9%, 75.6% and 107.6% while PCR reduced by 6.9, 8.0 and 8.8 at given intervals. Comparison of open and laparoscopic procedures showed no significant difference. Review of failed pyeloplasty showed failure of reduction in APD (APD > 3 cm or < 25% reduction) and PCR (PCR > 4) as early indicators for failure.
Conclusion
Both APD and PCR are reliable indicators of success and failure following pyeloplasty while CT alone is not as useful. Laparoscopic procedures are non-inferior to standard open surgery.