Renal Cortical Thickness After Pyeloplasty in Pediatric Ureteropelvic Junction Obstruction

Abstract

Purpose: The main goal of pyeloplasty is to maintain or improve renal function. Diuretic renography is the gold standard for evaluating renal function after pyeloplasty. Renal ultrasonography (RUS) is commonly used to determine hydronephrosis in pediatric patients. We hypothesized that the change in the renal parenchymal cortex would predict pyeloplasty success. In this study, we aim to measure renal cortical thickness change after pyeloplasty in ureteropelvic junction obstruction patients. Materials and Methods: We retrospectively reviewed 38 patients who underwent pyeloplasty between 2005 and 2019. We divided patients into three age groups and compared the difference of renal parenchymal thickness change by using generalized estimating equations to identify associated factors for renal cortical thickness change after pyeloplasty. Results: Thirty-nine kidney units were identified. The median age at the time of surgery was 41.61±40.99 months. Generalized estimating equations showed significant change of renal parenchymal thickness over the period of follow-up (p=0.02). The estimate of thickness change was 0.0373 mm/month. Age at the time of surgery was not associated with significant renal cortical thickness over the period of follow-up. The positive predictive factors for renal cortical thickness were creatinine clearance, pre-operative anteroposterior diameter and preoperative renal differential function. The negative factors for decrease of renal cortical thickness were body weight, presentation with abdominal mass, and history of infection. Conclusion:Renal cortical thickness after pyeloplasty was improved over the period of follow-up. Age at surgery was not associated with improvement of renal parenchymal thickness.

The Success of Pyeloplasty in Adult Patients with Ureteropelvic Junction Obstruction: A Retrospective Clinical Study

“…In children, it was shown that renal parenchymal thickness increases after pyeloplasty. 31 We detected a significant decrease in hydronephrosis and a significant increase in parenchymal thickness after pyeloplasty in adults. In the study of Isoyama et al, it was reported that in 73% of the cases one grade of improvement, and in 27% of the cases 2 grades of improvement in hydronephrosis were detected 6 months after the surgery.…”

Sonographic follow-up after pyeloplasty: a large, retrospective cohort analysis

“…Others have proposed combining US parameters together to obtain better outcome. Parenchymal/ cortical thickness is not affected by surgery itself and shows improvements after surgery [13,14]. PCR combines parenchymal thickness with degree of hydronephrosis, while CPR has the advantage of both parameters are not being directly manipulated by surgery.…”