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KMID : 1218220110030010023
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Korean Journal of Pediatric Urology
2011 Volume.3 No. 1 p.23 ~ p.28
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Differential Renal Function Before and After Pyeloplasty: Comparison according to Patient Age
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Park Yu-Jun
Shin Hong-Seok
Park Jae-Shin
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Abstract
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Purpose: Pyeloplasty is a widely accepted method for treating ureteropelvic junction obstruction (UPJO). Improved renal function after reconstructive surgery in infants has been reported in many studies. However, renal functional studies in adults are very limited. We determined whether there is any difference in post-operative renal functional improvement associated with patient age.
Materials and Methods: We retrospectively reviewed renography data for 17 patients who underwent pyeloplasty from January 2001 to December 2010. Group A, consisting of patients younger than 6 years, was compared with group B, consisting of individuals older than 6 years. Group A included eight patients with seven males and one female ranging
from 2 to 55 months of age (median age: 12 months). Group B consisted of nine patients with seven males and two females ranging from 8 to 55 years old (median age: 14 years). The median follow-up period for the 17 patients was 34 months with a range of 3 months to 5 years. We reviewed the data from pre-operative and the last post-operative
standardized diuretic renograms. Uptake of isotope between 1 and 3 minutes after radionuclide injection was used to monitor differential renal function (DRF).
Results: The pre-operative DRF ranged from 0.9% to 56.7% (mean: 33.7%) while the post-operative DRF was 24.3% to 59.7% (mean: 44.9%). DRF significantly improved post-operatively (paired t-test, p＜0.05). In Group A, DRF significantly improved from 24.4%±17.4 to 45.8%±7.0 (paired sample t-test, p=0.028). In Group B, DRF did not change significantly (43.7%±10.6 to 42.8%±10.8; paired sample t-test, p=0.750). The degree of improvement for renal function was significantly different between the two groups (Pearson’s correlation analysis, p=0.021).
Conclusions: Compared to the findings in children, renal function in adults did not show any improvement after pyeloplasty. These findings may need to be confirmed by a randomized study of adults with UPJO that compares surgical management with watchful-waiting with a well-designed control group.
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KEYWORD
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Ureteropelvic junction obstruction, Pyeloplasty, Renal scan
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