Journal of pediatric urology · 2025
Growth of the renal medullary pyramidal thickness following pyeloplasty in children with congenital unilateral hydronephrosis.
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Grandgenett Ryan P, Perry Sarah S, Cooper Christopher S
Аннотация
INTRODUCTION: Children with hydronephrosis who undergo pyeloplasty for ureteropelvic junction (UPJ) obstruction are frequently monitored postoperatively with ultrasonographic imaging and, if indicated, mercaptoacetyltriglycine (MAG3) renal scans. In the preoperative evaluation, the renal medullary pyramidal thickness (PT) has been demonstrated as an objective and reliable measurement that can predict risk for pyeloplasty and significantly decreased relative renal function. However, there is little published data on changes in PT postoperatively. This study evaluated postoperative changes in PT in both the operated kidney and the non-hydronephrotic contralateral kidney.
OBJECTIVE: To determine changes in PT after surgery we evaluated a series of measurements from preoperative and postoperative ultrasonographs of both the hydronephrotic and contralateral kidney. We assessed the average growth of PT in each kidney, the ratio between the hydronephrotic and contralateral kidney PT, and the growth rate of PT in each kidney during the first 2 years after pyeloplasty.
STUDY DESIGN: We retrospectively reviewed 88 patients with Society for Fetal Urology grade 3 or 4 unilateral hydronephrosis who underwent pyeloplasty from 0 to 2 years of age. Preoperative PT measurements and renal function were obtained from preoperative ultrasounds and MAG3 with furosemide scans. Post-pyeloplasty measurements were obtained from serial ultrasonographs during the first 2 years after the operation. A prediction of expected PT change over this period was developed using a linear mixed effects model. Two patients with an increased anteroposterior diameter of the renal pelvis and a decreased PT were diagnosed with recurrent UPJ obstruction and underwent reoperative pyeloplasty.
DISCUSSION AND CONCLUSIONS: The PT of the infant hydronephrotic kidney increased in the first 2 years following pyeloplasty at a significantly greater rate than the contralateral non-hydronephrotic kidney. A kidney with persistent hydronephrosis and lower than the anticipated increase in PT following infant pyeloplasty may serve as an additional sign of a degree of ongoing obstruction.
OBJECTIVE: To determine changes in PT after surgery we evaluated a series of measurements from preoperative and postoperative ultrasonographs of both the hydronephrotic and contralateral kidney. We assessed the average growth of PT in each kidney, the ratio between the hydronephrotic and contralateral kidney PT, and the growth rate of PT in each kidney during the first 2 years after pyeloplasty.
STUDY DESIGN: We retrospectively reviewed 88 patients with Society for Fetal Urology grade 3 or 4 unilateral hydronephrosis who underwent pyeloplasty from 0 to 2 years of age. Preoperative PT measurements and renal function were obtained from preoperative ultrasounds and MAG3 with furosemide scans. Post-pyeloplasty measurements were obtained from serial ultrasonographs during the first 2 years after the operation. A prediction of expected PT change over this period was developed using a linear mixed effects model. Two patients with an increased anteroposterior diameter of the renal pelvis and a decreased PT were diagnosed with recurrent UPJ obstruction and underwent reoperative pyeloplasty.
DISCUSSION AND CONCLUSIONS: The PT of the infant hydronephrotic kidney increased in the first 2 years following pyeloplasty at a significantly greater rate than the contralateral non-hydronephrotic kidney. A kidney with persistent hydronephrosis and lower than the anticipated increase in PT following infant pyeloplasty may serve as an additional sign of a degree of ongoing obstruction.