Scintigraphic renal function after unilateral pyeloplasty in children: a systematic review

Abstract

OBJECTIVE To systematically review previous reports and thus determine the functional outcome after pyeloplasty in children with unilateral hydronephrosis due to pelvi‐ureteric junction obstruction, and the possible variables that could affect it. METHODS We searched Medline/PubMed, Embase, and Web of Science for articles in English published from 1966 to 2007, using both ‘medical subject headings’ and ‘free text’ protocols. Abstracts, full texts, and bibliographies of pertinent papers were reviewed to select studies of scintigraphic renal function before and after pyeloplasty. The postoperative change in scintigraphic renal function was assessed in relation to presentation (antenatal vs postnatal), timing of surgery (early vs delayed), age at surgery, and preoperative ultrasonography (US) and scintigraphic findings. RESULTS Thirty‐six studies (2.1% of the initial search) were eventually selected for review. Studies were generally of poor scientific quality and very heterogeneous in their indications for surgery and follow‐up protocols. Postoperative function showed a wide variability. Symptomatic patients diagnosed postnatally seemed to have a greater chance of functional improvement after surgery than asymptomatic patients diagnosed antenatally. The chance of improvement seemed also to be greater in patients with moderately rather than severely impaired preoperative function. Otherwise, the improvement seemed unrelated to the age at surgery, the preoperative US findings, or the excretion pattern on renal scintigraphy. Of patients having delayed surgery >97.5% had preserved function afterward. CONCLUSIONS Patients with moderately impaired preoperative function and those diagnosed postnatally because of symptoms are those with the greatest likelihood of having a functional improvement after surgery.

Evaluation of Factors Predicting Recoverability of Renal Function after Pyeloplasty in Adults

“…Although the goal of pyeloplasty is primarily to preserve renal function and provide symptomatic relief, recoverability of renal function is a matter of debate and has been a subject of extensive literature research, especially in the pediatric population [1,3,6,9,10,11]. We showed that the overall DRF and SKGFR were significantly improved after relief of obstruction.…”

“…However, our report has several limitations in that it is retrospective and, in addition, we estimated the recoverability of renal function based on diuretic scintigraphy whose accuracy has been questioned [2,9]. Although postoperative diuretic scintigraphy has been performed at a median follow-up of 11 months, not all patients underwent scintigraphy at the same intervals.…”

Gravity-assisted drainage imaging in the assessment of pediatric hydronephrosis

“…15 There are several limitations to our study. Our data were obtained retrospectively, which limited the type of information we could collect and the types of statistical analyses we could perform.…”

“…14 A systematic review in this area by Castagnetti et al (2008) concluded that symptomatic patients diagnosed postnatally, and those with moderate rather than severely compromised preoperative function seem to have the greatest chance of functional improvement after surgery. 15 There are several limitations to our study.…”

Surgically Correctable Fetal Anomalies: Ultrasound Diagnosis and Management

“…The ureteropelvic junction is the most common site of congenital urinary obstruction above the level of the bladder. 19,20 The resulting hydronephrosis may be unilateral or bilateral. In adults, pulsed Doppler sonography was used for the diagnosis of lower pole arteries, which cross the ureteropelvic junction and are possibly the reason for hydronephrosis.…”