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Management dilemma in pelvi-ureteric junction obstruction: is transit time the answer?

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Abstract

Purpose

Pelvi-ureteric junction obstruction (PUJO) is the leading cause for hydronephrosis in children. Diuretic renography used in the pre- and post-operative evaluation of pyeloplasty may not be reliable in predicting the outcome.

Methods

A prospective study was conducted from October 2018 to November 2020, including all children with unilateral PUJO undergoing Pyeloplasty. Renal diuretic renography scans done in the pre and post operative periods were assessed for transit time. The time taken for the isotope to reach the renal pelvis was noted by a single observer as the transit time, from the dynamic frames of the diuretic renogram.

Results

Of the 65 children, 74% were boys. The transit time (median) in the preoperative renography was 10 min, whereas the same was 4 min 45 s in the postoperative period, the decrease was statistically significant.

On evaluation of transit time with ROC (receiver operating characteristics) curve, a cut-off of 4 min and 25 s was arrived at, which could identify the delayed drainage reliably.

Conclusion

Improvement in transit time is a reliable predictor of renal function improvement after pyeloplasty, comparing favorably in relation to split renal function.

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References

  1. Mallik M, Watson AR (2008) Antenatally detected urinary tract abnormalities: more detection but less action. Pediatr Nephrol 23(6):897–904

    Article  PubMed  Google Scholar 

  2. Nguyen HT, Herndon CA, Cooper C, Gatti J, Kirsch A, Kokorowski P et al (2010) The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 6(3):212–231

    Article  PubMed  Google Scholar 

  3. Mendelsohn C (2004) Functional obstruction: the renal pelvis rules. J Clin Inv 113(7):957–959

    Article  CAS  Google Scholar 

  4. Carr MC, El-Ghoneimi A (2007) Anomalies and surgery of the ureteropelvic junction obstruction in children. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbell-walsh urology, 9th edn. Saunders- Elsevier, Philadelphia, p 3359

    Google Scholar 

  5. Schlotmann A, Clorius JH, Clorius SN (2009) renography in hydronephrosis: renal tissue tracer transit predicts functional course and thereby need for surgery. Eur J Nucl Med Mol Imaging 36:1665e73

    Article  Google Scholar 

  6. Zhang PL, Peters CA, Rosen S (2000) Ureteropelvic junction obstruction: morphological and clinical studies. Pediatr Nephrol 14(8):820–826

    Article  CAS  PubMed  Google Scholar 

  7. Kajbafzadeh AM, Elmi A, Talab SS, Emami H, Esfahani SA, Saeedi P (2010) Urinary and serum carbohydrate antigen 19–9 as a biomarker in ureteropelvic junction obstruction in children. J urol 183(6):2353–2360

    Article  CAS  PubMed  Google Scholar 

  8. Harper L, Bourquard D, Grosos C, Abbo O, Ferdynus C, Michel JL et al (2013) Cortical transit time as a predictive marker of the need for surgery in children with pelvi-ureteric junction stenosis: preliminary study. J Pediatr Urol 9:1054e8

    Article  Google Scholar 

  9. Duong HP, Piepsz A, Collier F, Khelif K, Christophe C, Cassart M et al (2013) Predicting the clinical outcome of antenatally Predictive value of cortical transit time on MAG3 for surgery 55.e5 detected unilateral pelviureteric junction stenosis. Urology 82:691e6

    Article  Google Scholar 

  10. Sharma G, Sharma A (2017) Usefulness of ultrasonography and cortical transit time to differentiate nonobstructive from obstructive dilatation in the management of prenatally detected pelvic ureteric junction like obstruction. Urology 110:208–212

    Article  PubMed  Google Scholar 

  11. Jain V, Kumar R, Arora S, Mani K, Agarwala S, Yadav DK et al (2020) Cortical transit time: understanding utility and pitfalls in children with pelviureteric junction obstruction. J Pediatr Urol S1477–5131(20):30042–30045

    Google Scholar 

  12. Britton KE, Nimmon CC, Whitfield HN, Hendry WF, Wickham JE (1979) Obstructive nephropathy: successful evaluation with radionuclides. Lancet 1:905–907

    Article  CAS  PubMed  Google Scholar 

  13. Sharma GR, Panda A, Sharma AG (2021) Renal cortical transit time in the evaluation of prenatally detected presumed pelvi ureteric junction like obstruction: a systematic review. Indian J Urol 37(2):116–124

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Departments of Pediatric Surgery & 1 Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

    Aishwarya Malla, Krishna Kumar Govindarajan, Madhusudhanan Ponnusamy, Kumaravel Sambandan, Bikash Kumar Naredi & Bibekanand Jindal

Authors
  1. Aishwarya Malla
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  2. Krishna Kumar Govindarajan
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  3. Madhusudhanan Ponnusamy
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  4. Kumaravel Sambandan
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  5. Bikash Kumar Naredi
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  6. Bibekanand Jindal
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Contributions

AM: preparation of manuscript and data analysis. KK: study concept, design, supervision and funding. MP: data analysis. KS: data collection. BK: data collection. BJ: data collection.

Corresponding author

Correspondence to Krishna Kumar Govindarajan.

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Malla, A., Govindarajan, K.K., Ponnusamy, M. et al. Management dilemma in pelvi-ureteric junction obstruction: is transit time the answer?. Pediatr Surg Int 39, 120 (2023). https://doi.org/10.1007/s00383-023-05404-2

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  • DOI: https://doi.org/10.1007/s00383-023-05404-2

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