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571 ULTRASONOGRAPHY RENAL PARENCHYMAL AREA PREDICTS VESICOURETERAL REFLUX AFTER URINARY TRACT INFECTION
e230
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
570
571
THE ULTRASONOGRAPHIC EVOLUTION OF THE HYDRONEPHROSIS AND RENAL PARENCHYMA THICKNESS IN PATIENTS WITH CONGENITAL URETEROPELVIC JUNCTION (UPJ) OBSTRUCTION WHO UNDERWENT PYELOPLASTY
ULTRASONOGRAPHY RENAL PARENCHYMAL AREA PREDICTS VESICOURETERAL REFLUX AFTER URINARY TRACT INFECTION
Yuri Ferreira, Eleazar Araújo, Fernando Cabral, Monica Pereira, Fernando Gurgel, Joa˜o Guilherme Alves, Adriano Calado*, Recife, Brazil
INTRODUCTION AND OBJECTIVES: Children who have urinary tract infection (UTI) have risk of vesicoureteral reflux (VUR). There are few factors with which to predict VUR likelihood prior to VCUG and there are no standardized stratification criteria. For this reason clinical effectiveness of performing voiding cystourethrogram (VCUG) in children after UTI is controversial. We have shown that ultrasonography renal parenchymal area (RPA) correlates with vesicoureteral reflux (VUR) in children with UTI. We examined whether RPA can predict VUR in children undergoing VCUG for UTI. METHODS: With human subjects approval for database maintenance, we searched radiology requests designating UTI as reason for VCUG from 2000 –2008 at Lucile Packard Children’s Hospital Stanford. Children from 2–72 months of age with a VCUG and renal and bladder ultrasonogram performed within 6 weeks were analyzed. Children with systemic diseases other than UTI and/or VUR and those with other concomitant genitourinary abnormalities were eliminated from study. Using NIH Scion imaging software, RPA was determined for right and left kidneys. Patient age, left and right RPA, VUR status, and grade were recorded. RPA for right, left, and total (R⫹L) were analyzed by patient age and VUR status. Patient data were analyzed for statistical differences between groups using SAS software. RESULTS: From over 3000 VCUG requisitions, 312 children (624 kidneys) with UTI were evaluated; 187 have no VUR, 66 have bilateral and 59 unilateral VUR ranging from grades 1–5. 37 kidneys demonstrate severe VUR (grades 4 –5) and 145 some VUR (grades 1–3). RPA for kidneys without VUR and those with severe VUR show significant differences. RPA for kidneys with VUR (grades 1–3) and VUR (grades 4 –5) also differ. Renal size discrepancies with VUR appear to persist with increasing patient age. When L⫹R data are analyzed in quartiles by age, a model utilizing R⫹L and age predicts likelihood of severe VUR (grades 4 –5) with an ROC curve (for sensitivity versus 1-Specificity) of 0.745. CONCLUSIONS: In children having VCUG for UTI, children can be grouped into those who have VUR and those who do not. Children with UTI who have VUR on VCUG have decreased RPA and those who have severe VUR (grades 4 –5) can be predicted with high likelihood using this model. RPA may be a useful factor in determining VUR risk in children who have UTI and advising which should undergo VCUG. Further investigation of RPA measurement and prospective testing are required to determine clinical utility of this model.
INTRODUCTION AND OBJECTIVES: Introduction: Pyeloplasty is an established treatment for pelviureteric junction (UPJ) obstruction. After pyeloplasty diuretic renograms are often obtained to document surgical success by demonstrating better urinary drainage. However, while diuretic renograms may be the most accurate way to evaluate surgical outcome in the early postoperative period, renal ultrasound is more commonly used for long-term followup because it is less invasive and more cost-effective. OBJECTIVE: The aim of this study was to determine the ultrasonographic evolution of the pelvic and caliceal dilatations and of the renal parenchyma thickness in patients with congenital hydronephrosis who underwent pyeloplasty. METHODS: Materials and Methods: From January 2006 to January 2010, 265 patients with prenatally diagnosed hydronephrosis underwent a protocol of antibiotic prophylaxis, ultrasound, diuretic renography(DTPA) and voiding cystourethrography. Of the 265 patients, 85 (32%) who showed a trend of progressive hydronephrosis underwent pyeloplasty and were included. All the patients were evaluated with DTPA scans on the sixth month after surgery. The ultrasound performed before the surgery as well as all performed in the first 3,6,12,24 and 36 months after the pyeloplasty were reviewed and compared. The trends in the changes in these studies were studied. Statistical analyses were performed with SPSS (Statistical Package for the Social Sciences) version 18.0. RESULTS: All patients significantly improved the renal washout time (T1⁄2) in DTPA scans at six months postoperatively. The rate of caliceal dilatation decrease in the first 3, 6 and 12 months after surgery were 60%, 91,7%, and 100%, respectively. In a follow-up period of at least 1 year, 43 (50,6%) renal units had complete resolution of the pelvic dilation and 72 (84.7%) of the caliceal dilatation. The renal parenchyma was normal or had increased in 76 (89,4 %) of cases. CONCLUSIONS: The decrease in pelvic and caliceal dilatations occurred in the majority of the patients, but its complete resolution is relatively slow. Serial ultrasound is noninvasive and could replace serial invasive renal scans decreasing costs, instrumentation, and radiation exposure.
Liam MacLeod*, Raymond Balise, Linda Shortliffe, Stanford, CA
Source of Funding: Lucile Salter Packard Pediatric Research Fund and Stanford University School of Medicine Medical Scholars Fund
572 THE ROLE OF THERAPEUTIC DELAY TIME IN ACUTE SCINTIGRAPHIC LESION AND ULTIMATE SCAR FORMATION IN CHILDREN WITH FIRST FEBRILE UTI; IS THERE DIFFERENCE ACCORDING TO THE PRESENCE OF VESICO-URETERAL REFLUX? MiMi Oh*, Du Geon Moon, Jae Hyun Bae, Seok Ho Kang, Je Jong Kim, Jeong Gu Lee, Duck Gi Yoon, Seoul, Korea, Republic of Source of Funding: None
INTRODUCTION AND OBJECTIVES: We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR).
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
570
571
THE ULTRASONOGRAPHIC EVOLUTION OF THE HYDRONEPHROSIS AND RENAL PARENCHYMA THICKNESS IN PATIENTS WITH CONGENITAL URETEROPELVIC JUNCTION (UPJ) OBSTRUCTION WHO UNDERWENT PYELOPLASTY
ULTRASONOGRAPHY RENAL PARENCHYMAL AREA PREDICTS VESICOURETERAL REFLUX AFTER URINARY TRACT INFECTION
Yuri Ferreira, Eleazar Araújo, Fernando Cabral, Monica Pereira, Fernando Gurgel, Joa˜o Guilherme Alves, Adriano Calado*, Recife, Brazil
INTRODUCTION AND OBJECTIVES: Children who have urinary tract infection (UTI) have risk of vesicoureteral reflux (VUR). There are few factors with which to predict VUR likelihood prior to VCUG and there are no standardized stratification criteria. For this reason clinical effectiveness of performing voiding cystourethrogram (VCUG) in children after UTI is controversial. We have shown that ultrasonography renal parenchymal area (RPA) correlates with vesicoureteral reflux (VUR) in children with UTI. We examined whether RPA can predict VUR in children undergoing VCUG for UTI. METHODS: With human subjects approval for database maintenance, we searched radiology requests designating UTI as reason for VCUG from 2000 –2008 at Lucile Packard Children’s Hospital Stanford. Children from 2–72 months of age with a VCUG and renal and bladder ultrasonogram performed within 6 weeks were analyzed. Children with systemic diseases other than UTI and/or VUR and those with other concomitant genitourinary abnormalities were eliminated from study. Using NIH Scion imaging software, RPA was determined for right and left kidneys. Patient age, left and right RPA, VUR status, and grade were recorded. RPA for right, left, and total (R⫹L) were analyzed by patient age and VUR status. Patient data were analyzed for statistical differences between groups using SAS software. RESULTS: From over 3000 VCUG requisitions, 312 children (624 kidneys) with UTI were evaluated; 187 have no VUR, 66 have bilateral and 59 unilateral VUR ranging from grades 1–5. 37 kidneys demonstrate severe VUR (grades 4 –5) and 145 some VUR (grades 1–3). RPA for kidneys without VUR and those with severe VUR show significant differences. RPA for kidneys with VUR (grades 1–3) and VUR (grades 4 –5) also differ. Renal size discrepancies with VUR appear to persist with increasing patient age. When L⫹R data are analyzed in quartiles by age, a model utilizing R⫹L and age predicts likelihood of severe VUR (grades 4 –5) with an ROC curve (for sensitivity versus 1-Specificity) of 0.745. CONCLUSIONS: In children having VCUG for UTI, children can be grouped into those who have VUR and those who do not. Children with UTI who have VUR on VCUG have decreased RPA and those who have severe VUR (grades 4 –5) can be predicted with high likelihood using this model. RPA may be a useful factor in determining VUR risk in children who have UTI and advising which should undergo VCUG. Further investigation of RPA measurement and prospective testing are required to determine clinical utility of this model.
INTRODUCTION AND OBJECTIVES: Introduction: Pyeloplasty is an established treatment for pelviureteric junction (UPJ) obstruction. After pyeloplasty diuretic renograms are often obtained to document surgical success by demonstrating better urinary drainage. However, while diuretic renograms may be the most accurate way to evaluate surgical outcome in the early postoperative period, renal ultrasound is more commonly used for long-term followup because it is less invasive and more cost-effective. OBJECTIVE: The aim of this study was to determine the ultrasonographic evolution of the pelvic and caliceal dilatations and of the renal parenchyma thickness in patients with congenital hydronephrosis who underwent pyeloplasty. METHODS: Materials and Methods: From January 2006 to January 2010, 265 patients with prenatally diagnosed hydronephrosis underwent a protocol of antibiotic prophylaxis, ultrasound, diuretic renography(DTPA) and voiding cystourethrography. Of the 265 patients, 85 (32%) who showed a trend of progressive hydronephrosis underwent pyeloplasty and were included. All the patients were evaluated with DTPA scans on the sixth month after surgery. The ultrasound performed before the surgery as well as all performed in the first 3,6,12,24 and 36 months after the pyeloplasty were reviewed and compared. The trends in the changes in these studies were studied. Statistical analyses were performed with SPSS (Statistical Package for the Social Sciences) version 18.0. RESULTS: All patients significantly improved the renal washout time (T1⁄2) in DTPA scans at six months postoperatively. The rate of caliceal dilatation decrease in the first 3, 6 and 12 months after surgery were 60%, 91,7%, and 100%, respectively. In a follow-up period of at least 1 year, 43 (50,6%) renal units had complete resolution of the pelvic dilation and 72 (84.7%) of the caliceal dilatation. The renal parenchyma was normal or had increased in 76 (89,4 %) of cases. CONCLUSIONS: The decrease in pelvic and caliceal dilatations occurred in the majority of the patients, but its complete resolution is relatively slow. Serial ultrasound is noninvasive and could replace serial invasive renal scans decreasing costs, instrumentation, and radiation exposure.
Liam MacLeod*, Raymond Balise, Linda Shortliffe, Stanford, CA
Source of Funding: Lucile Salter Packard Pediatric Research Fund and Stanford University School of Medicine Medical Scholars Fund
572 THE ROLE OF THERAPEUTIC DELAY TIME IN ACUTE SCINTIGRAPHIC LESION AND ULTIMATE SCAR FORMATION IN CHILDREN WITH FIRST FEBRILE UTI; IS THERE DIFFERENCE ACCORDING TO THE PRESENCE OF VESICO-URETERAL REFLUX? MiMi Oh*, Du Geon Moon, Jae Hyun Bae, Seok Ho Kang, Je Jong Kim, Jeong Gu Lee, Duck Gi Yoon, Seoul, Korea, Republic of Source of Funding: None
INTRODUCTION AND OBJECTIVES: We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR).