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

Yıl 2024, , 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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

Child, Hydronephrosis, Kidney pelvis, Ultrasonography

Kaynakça

• Kelley JC, White JT, Goetz JT, Romero E, Leslie JA, Prieto JC. Sonographic Renal Parenchymal Measurements for the Evaluation and Management of Ureteropelvic Junction Obstruction in Children. Front Pediatr 2016;4:42.
• Weitz M, Schmidt M, Laube G. Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol 2017;32:2203-13.
• Ozaydin S, Celebi S. Ureteropelvic junction obstructions: Is side a prognostic factor? Niger J Clin Pract 2022;25:1357-60.
• Li Y, He Y, Zhang W, Song H, Wang T. Factors predicting improvement of differential renal function after pyeloplasty in children of ureteropelvic junction obstruction. J Pediatr Urol 2022;18:504.e1-.e6.
• Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. Adv Clin Exp Med 2017;26:857-64.
• Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis 2015;43:5-12.
• Vemulakonda VM. Ureteropelvic junction obstruction: diagnosis and management. Curr Opin Pediatr 2021;33:227-34.
• Silay MS, Spinoit AF, Bogaert G, Hoebeke P, Nijman R, Haid B. Imaging for Vesicoureteral Reflux and Ureteropelvic Junction Obstruction. Eur Urol Focus 2016;2:130-8.
• Ucar AK, Kurugoglu S. Urinary Ultrasound and Other Imaging for Ureteropelvic Junction Type Hydronephrosis (UPJHN). Front Pediatr 2020;8:546.
• Çamlar SA, Deveci N, Soylu A, Türkmen MA, Özmen D, Çapakaya G, et al. The role of dynamic renal scintigraphy on clinical decision making in hydronephrotic children. Saudi J Kidney Dis Transpl 2017;28:76-80.
• Khan F, Ahmed K, Lee N, Challacombe B, Khan MS, Dasgupta P. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol 2014;11:629-38.
• Ostrowski DA, Logan JR, Antony M, Broms R, Weiss DA, Van Batavia J, et al. Automated Society of Fetal Urology (SFU) grading of hydronephrosis on ultrasound imaging using a convolutional neural network. J Pediatr Urol 2023;19:566.e1-.e8.
• AL Baert MK, Sartor K. Pediatric Uroradiology Medical Radiology. 2nd Revised Edition ed. Verlag Berlin Heidelberg: Springer 2008:37-53.
• Sandler MP CR, Patton JA, Wackers FJT, Gottschalk A. Diagnostic nuclear medicine. 4th ed. Lippincott Williams Wilkins 2003:42: 865-902.
• Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ. Society for Fetal Urology Classification vs Urinary Tract Dilation Grading System for Prognostication in Prenatal Hydronephrosis: A Time to Resolution Analysis. J Urol 2018;199:1615-21.
• Ahmed Mahmoud T, El Din Salem Morsy E, Abd Elraoof Ali Morsy H, Mohammed Abouzeid A, Abd Elhamed AM, Mohamed ER, et al. Can pyeloplasty restore normal renal function in patients with severe unilateral ureteropelvic junction obstruction and DRF < 35. J Pediatr Urol 2023;19:310.e1-.e5.
• Cai PY, Lee RS. Ureteropelvic Junction Obstruction/Hydronephrosis. Urol Clin North Am 2023;50:361-9.
• Arena S, Chimenz R, Antonelli E, Peri FM, Romeo P, Impellizzeri P, et al. A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr 2018;177:1761-5.
• Yalçınkaya F, Özçakar ZB. Management of antenatal hydronephrosis. Pediatr Nephrol 2020;35:2231-9.
• Jiang D, Tang B, Xu M, Lin H, Jin L, He L, et al. Functional and Morphological Outcomes of Pyeloplasty at Different Ages in Prenatally Diagnosed Society of Fetal Urology Grades 3-4 Ureteropelvic Junction Obstruction: Is It Safe to Wait? Urology 2017;101:45-9.
• Kohno M, Ogawa T, Kojima Y, Sakoda A, Johnin K, Sugita Y, et al. Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide. Int J Urol 2020;27:369-76.
• Schreuder MF. Unilateral anomalies of kidney development: why is left not right? Kidney Int 2011;80:740-5.
• Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010;6:212-31.
• Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993;23:478-80.
• Arora S, Yadav P, Kumar M, Singh SK, Sureka SK, Mittal V, et al. Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction--a prospective multivariate analysis. J Pediatr Urol 2015;11:248.e1-5.
• Çetin N TB. Ureteropelvic Junction Obstruction in Children: Single-Center Experience Firat Med J 2017;22:77-80.
• Tabari AK, Atqiaee K, Mohajerzadeh L, Rouzrokh M, Ghoroubi J, Alam A, et al. Early pyeloplasty versus conservative management of severe ureteropelvic junction obstruction in asymptomatic infants. J Pediatr Surg 2020;55:1936-40.
• Yang Y, Hou Y, Niu ZB, Wang CL. Long-term follow-up and management of prenatally detected, isolated hydronephrosis. J Pediatr Surg 2010;45:1701-6.
• Khawaja AR, Dar TI, Bashir F, Sharma A, Tyagi V, Bazaz MS. Stentless laparoscopic pyeloplasty: A single center experience. Urol Ann 2014;6:202-7.
• Mahmoud TA, Morsy E, Morsy H, Abouzeid AM, Elmoghazy HM. Predictors of surgical intervention for antenatally detected ureteropelvic junction obstruction (UPJO): A prospective multivariate analysis. Urologia 2024;91:220-5.
• Sharifian M, Esfandiar N, Mohkam M, Dalirani R, Baban Taher E, Akhlaghi A. Diagnostic accuracy of renal pelvic dilatation in determining outcome of congenital hydronephrosis. Iran J Kidney Dis 2014;8:26-30.
• Wang J, Ying W, Tang D, Yang L, Liu D, Liu Y, et al. Prognostic value of three-dimensional ultrasound for fetal hydronephrosis. Exp Ther Med 2015;9:766-72.