Número de confirmación: 2155488
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A world without renal scans: ultrasound is enough for pediatric pyeloplasty follow-up? Silva Ramos, Y(1); Rebello Horta Gorgen, A(1); Paula dos Santos, M(1); Regina Siqueira Lucena, I(2); Timóteo de Oliveira, R(1); Cesár Rosito, N(3); Machado Tavares, P(1); Elias Rosito, T(1) (1)Serviço de Urologia, Hospital de Clínicas de Porto Alegre. Porto Alegre, Brasil (2)Serviço de Radiologia, Hospital de Clínicas de Porto Alegre. Porto Alegre, Brasil (3)Serviço de Cirurgia Pediátrica , Hospital de Clínicas de Porto Alegre. Porto Alegre, Brasil Introduction: Pyeloplasty is the standard treatment of ureteropelvic junction obstruction (UPJO) with high success rates reported in children. The anteroposterior diameter (APD) of the renal pelvis on ultrasound was postulated as the most reliable variable for follow-up , and the reduction in its diameter would be indicative of urinary tract clearance. The aim of the study is to evaluate the validity of ultrasound as the only exam in the postoperative follow-up as a predictor of urinary tract patency. Materials and Methods: A retrospective study was performed. Data were collected from patients undergoing open and laparoscopic pyeloplasty in the pediatric age (0-18 years) from 2005 to 2021. Patients with available preoperative and postoperative ultrasound were included in the study. Pre and postoperative APD measurements were analyzed and the APD variation (ΔAPD) was related to urinary desobstruction and the need for repyeloplasty. Results: Sixty-six patients who underwent pyeloplasty with preoperative and postoperative ultrasound and follow-up of 2 years were included. For early ultrasound (< 3 months), 67% of patients (24/36) had a decrease in the APD and for late ultrasound ( > 6 months) 84% (52/62) had a decrease in APD. Only one patient needed repyeloplasty, and he had an increase of 11m (55%) in the ΔAPD. Discussion: Although there is no consensus on the method and the timing of post-pyeloplasty investigation, there is increasing data over the last decade that support a reduction of invasive imaging in follow-up. In our series, initial use of ultrasound was effective as it allowed us to avoid scintigraphy in 63% of the patients. Thus, scintigraphy could be reserved for selected cases, such as in patients with symptoms and /or with altered US, corroborating the results of other authors. Conclusion: According to our data the follow-up with ultrasound is sufficient, and renal scan is only needed if there is no improvement in the APD in the late ultrasound ( > 3 months). With this approach, we could potentially avoid renal scans in 63% of patients. |
Presentación al Congreso de la Sociedad Iberoamericana de Urología Pediátrica (SIUP)
Forma de presentación: Oral
Financiamiento / conflicto de intereses: No