Division of Pediatric Urology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, USA 15224.
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213.
J Pediatr Urol. 2020 Aug;16(4):472.e1-472.e6. doi: 10.1016/j.jpurol.2020.05.156. Epub 2020 May 29.
Dismembered pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). Although the frequency and timing of follow up imaging after pyeloplasty is variable, renal ultrasound (RUS) is commonly utilized. With minimal training, point-of-care ultrasound (POCUS) can be easily performed by a urologist during a post-operative visit.
Our hypothesis is that POCUS is an accurate, time-saving, and cost-effective alternative to a complete retroperitoneal ultrasound (CRUS) performed by the Radiology Department after pyeloplasty.
The clinical records of all children who underwent pyeloplasty (by any method) over a 12 month period at our institution were retrospectively reviewed. The exact timing and method (POCUS vs. CRUS) of follow up imaging was surgeon-dependent. Statistical analysis was performed to compare the time and cost of POCUS vs. CRUS. The clinical course of each patient who had each type of imaging was assessed.
A total 45 patients were included in this analysis. Over a mean follow up period of 29 months, a total of 73 CRUS and 67 POCUS were performed. Each CRUS on average added 2 h to each patient's healthcare encounter. Had the 73 CRUS been performed as POCUS instead, this would have corresponded to $83,751 less charges to payers. There was no difference in the rate of the detection of worsening, stable, or improved hydronephrosis (HN) between either modality (p > 0.05). The recommended follow up time for observed HN was no different between CRUS and POCUS (p > 0.05). Children with worsening HN on POCUS underwent functional studies without confirmatory CRUS. Interestingly, two patients had metachronous, contralateral UPJO discovered during post-operative imaging. These were both discovered by POCUS. Nineteen (42%) patients who had attended at least one post-operative visit were eventually loss to follow-up. This occurred exclusively in those who did not have worsening ultrasound (p < 0.01). There was no difference in the loss to follow-up after POCUS (8) or CRUS (12) (p > 0.05).
POCUS performed by a urologist is an accurate assessment of HN after pyeloplasty with time and cost savings to compared to a CRUS performed by a radiologist. POCUS is not associated with any difference in rate of detection of worsening HN or rate of loss to follow up.
离断式肾盂成形术被认为是治疗肾盂输尿管连接部梗阻（UPJO）的金标准。虽然肾盂成形术后随访的影像学检查的频率和时间各不相同，但肾脏超声（RUS）通常被应用。在经过少量培训后，泌尿科医生可以在术后就诊时轻松进行即时床旁超声（POCUS）检查。
我们的假设是，与放射科进行的完整腹膜后超声（CRUS）相比，POCUS 是一种准确、节省时间且具有成本效益的替代方法。
回顾性分析了我院在 12 个月内接受肾盂成形术（任何方法）的所有儿童的临床记录。随访影像学检查的具体时间和方法（POCUS 与 CRUS）取决于外科医生。进行了统计学分析，比较了 POCUS 与 CRUS 的时间和成本。评估了每位患者进行每种影像学检查的临床过程。
本分析共纳入 45 例患者。在平均 29 个月的随访期间，共进行了 73 次 CRUS 和 67 次 POCUS。每次 CRUS 平均增加了每位患者 2 小时的就诊时间。如果这 73 次 CRUS 都作为 POCUS 进行，那么这将为支付方节省 83751 美元的费用。两种检查方式在检测积水恶化、稳定或改善的发生率方面无差异（p＞0.05）。CRUS 和 POCUS 观察到的积水建议随访时间无差异（p＞0.05）。POCUS 检查发现积水恶化的患儿进行了功能研究，而无需进行确认性的 CRUS。有趣的是，两名患者在术后影像学检查中发现了同时性、对侧 UPJO。这些都是通过 POCUS 发现的。19 名（42%）接受过至少一次术后就诊的患者最终失去随访。这仅发生在那些超声检查无异常的患者中（p＜0.01）。POCUS 组（8 例）和 CRUS 组（12 例）的失访率无差异（p＞0.05）。
泌尿科医生进行的 POCUS 是肾盂成形术后评估积水的一种准确方法，与放射科进行的 CRUS 相比，具有时间和成本上的优势。POCUS 检查在发现积水恶化的发生率或失访率方面没有差异。
