Üreteropelvik Bileşke Darlığı Olan Çocuklarda Piyeloplasti Kararı Verilmesinde Ultrasonografi ve Dinamik Böbrek Sintigrafisinin Rolü

Year 2024, Volume: 18 Issue: 6, 367 - 372, 18.11.2024

Nesrin Taş , Arife Uslu Gökçeoğlu , Aylin Akbulut , Gökhan Koca , Koray Ağras , Meliha Korkmaz

https://doi.org/10.12956/tchd.1470638

Abstract

Amaç: Üreteropelvik bileşke darlığı (UPD) olan hastalarda cerrahi tedavinin zamanı konusunda çelişkili sonuçlar bulunmaktadır. Bu nedenle UPD tanı ve tedavisinde ultrasonografi (USG) ve dinamik böbrek sintigrafisi parametrelerinin öngörücü gücünü karşılaştırmayı amaçladık.

Gereç ve Yöntemler: 2015-2020 yılları arasında UPD tanısı alan hastalar geriye dönük olarak değerlendirildi, diğer konjenital üriner anomaliler dışlandı. Renal pelvis ön-arka çapı USG ile değerlendirildi ve Fetal Üroloji Derneği’nin derecelendirme sistemine göre evrelendi. Dinamik böbrek sintigrafisinde maksimum böbrek aktivitesine ulaşma süresi (Tmax), maksimum aktivitenin yarısının temizlenmesine kadar geçen süre (T1/2), diferansiyel böbrek fonksiyonu ve diüretik yanıtı kaydedildi.

Bulgular: Çalışmaya 59 hasta dahil edildi. Elli dokuz hastanın 13’üne (%22) piyeloplasti yapıldı Piyeloplasti grubunda (%22) piyeloplasti yapılmayan gruba göre yüksek dereceli hidronefroz tesbit edildi ve bu grupta renal pelvis ön-arka çapı daha fazlaydı. Ayrıca piyeloplasti grubunda Tmax ve T1/2 değerleri piyeloplasti yapılmayan gruba göre anlamlı derecede daha uzundu (p<0.010). İkili lojistik regresyon analizi, yalnızca renal pelvis ön-arka çap artışının piyeloplasti ile bağımsız olarak ilişkili olduğunu ortaya çıkardı (p = 0.030; olasılık oranı= 1.2). Piyeloplasti için en uygun renal pelvis ön-arka çap eşik değeri 21.5 mm olarak belirlendi. Duyarlılık ve özgüllük sırasıyla %84.0 ve %87.0’di.

Sonuç: Bulgularımız USG ve dinamik böbrek sintigrafisinin UPD olan hastalarda piyeloplasti yapılıp yapılmayacağının belirlenmesinde yararlı araçlar olduğunu göstermektedir. Ayrıca, pelvis ön-arka çapı ölçümü takip ve tedavide güvenilir, kolay ve ucuz bir yöntem olabilir.

Keywords

Çocuk, Hidronefroz, Renal pelvis, Ultrasonografi

Role of Ultrasonography and Dynamic Renal Scintigraphy Parameters in Decision Making Regarding Performance of Pyeloplasty in Children with Ureteropelvic Junction Obstruction

Abstract

Objective: There are conflicting results regarding the time of surgical treatment in patients with ureteropelvic junction obstruction (UPJO). Therefore, we aimed to compare the predictive power of ultrasonography (USG) and dynamic renal scintigraphy parameters in the diagnosis and treatment of UPJO.

Material and Methods: Patients diagnosed with UPJO between 2015 and 2020 were evaluated retrospectively, other congenital urinary anomalies were excluded. Renal pelvis anteroposterior diameter (APD) was evaluated by USG and staged according to the Society for Fetal Urology grading system. In dynamic renal scintigraphy, time to reach maximum renal activity (Tmax), time to clear half of the maximum activity (T1/2), differential renal function, and diuretic response were recorded.

Results: A total of 59 patients were included. Thirteen of 59 (22.0%) patients underwent pyeloplasty. The frequency of high-grade hydronephrosis and renal pelvis APD was higher in the pyeloplasty group than in the non-pyeloplasty group. In addition, Tmax and T1/2 were significantly longer in the pyeloplasty group than in the non-pyeloplasty group (p<0.010). Binary logistic regression analysis revealed that only increased renal pelvis APD was independently associated with pyeloplasty (p = 0.030; odds ratio = 1.2). An APD of 21.5 mm was the best cutoff value to identify patients requiring pyeloplasty. The sensitivity and specificity were 84.0% and 87.0%, respectively

Conclusion: Our findings suggest that USG and dynamic renal scintigraphy are useful tools for determining whether to perform pyeloplasty in patients with UPJO. Furthermore, APD can be a reliable, easy, and inexpensive method for follow-up and treatment.

Keywords

Child, Hydronephrosis, Kidney pelvis, Ultrasonography

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