Suárez Arbeláez María Camila, Nassau Daniel E, Cabrera Valencia Isabella, Blachman-Braun Rubén, Alam Alireza, Castellan Miguel
Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA; Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA.
J Pediatr Urol. 2022 Oct;18(5):662.e1-662.e7. doi: 10.1016/j.jpurol.2022.08.003. Epub 2022 Aug 18.
Although more than 1500 pediatric pyeloplasties are performed in the United States per year, there is a lack of consensus on the adequate imaging modality and timing of follow-up after surgery.
The aim of this study is to evaluate if ultrasonographic stabilization in the grade of hydronephrosis after pyeloplasty is an adequate parameter to define the optimal length of follow-up after surgery and to detect failed procedures. Secondarily, we want to analyze clinical variables that could impact ultrasonographic stabilization.
This is a retrospective chart review of patients who underwent pyeloplasty between 2012 and 2020. Patients were included if they were ≤21 years-old at the time of surgery, had pre and postoperative renal-ultrasounds, had ≥3 months of postoperative follow-up, and had met the criteria for ultrasonographic stabilization after surgery. Ultrasonographic stabilization was defined as 2 consecutive ultrasounds after pyeloplasty, a minimum of 1-month apart, with the same degree of hydronephrosis according to the Society for Fetal Urology (SFU) grading system. Data concerning clinical, surgical, and postoperative variables were collected.
A total of 143 pyeloplasties met the inclusion criteria. Median age at surgery was 10.5 months with a median post-operative follow-up time of 29 months. Ultrasonographic stabilization was achieved in a mean time of 14.5 months post-operatively. Compared to the preoperative US SFU grade, at ultrasonographic stabilization 127 (88.9%) patients had an improvement of ≥1 grades of hydronephrosis. There were 9 pyeloplasty failures that were diagnosed and surgically corrected in a median of 7.5 months after the initial surgery. No clinical or surgical variables were associated with time to achieve ultrasonographic stabilization.
There is great variability in the length of follow-up after pyeloplasty, ranging from 3-months to 7-years. In our cohort, the bast majority of patients had achieved ultrasonographic stabilization and displayed improvement in their initial grade of hydronephrosis by 14.5 months after surgery. Timeframe in which surgical failures were diagnosed and corrected. There were not clinical or surgical variables associated to time to achieve stabilization. Similar results have been reported in the literature; however, most of them have evaluated as their main outcome resolution and not stabilization of hydronephrosis.
Ultrasonographic stabilization is a suitable and non-invasive parameter for determining the length of follow-up after unilateral pyeloplasty, as it is an adequate timeframe for identifying failed pyeloplasties, observing improvement or stabilization of hydronephrosis, and performing any additional procedure required after the primary repair.
尽管美国每年进行超过1500例小儿肾盂成形术，但对于术后适当的影像学检查方式和随访时间缺乏共识。
本研究的目的是评估肾盂成形术后肾积水分级的超声稳定情况是否是确定术后最佳随访时长和检测手术失败的合适参数。其次，我们想要分析可能影响超声稳定的临床变量。
这是一项对2012年至2020年间接受肾盂成形术患者的回顾性图表审查。纳入标准为手术时年龄≤21岁、术前后均有肾脏超声检查、术后随访≥3个月且符合术后超声稳定标准的患者。超声稳定定义为肾盂成形术后连续两次超声检查，间隔至少1个月，根据胎儿泌尿外科学会（SFU）分级系统，肾积水程度相同。收集了有关临床、手术和术后变量的数据。
共有143例肾盂成形术符合纳入标准。手术时的中位年龄为10.5个月，术后中位随访时间为29个月。术后平均14.5个月实现超声稳定。与术前美国SFU分级相比，在超声稳定时，127例（88.9%）患者的肾积水改善≥1级。有9例肾盂成形术失败，在初次手术后中位7.5个月被诊断并接受手术纠正。没有临床或手术变量与实现超声稳定的时间相关。
肾盂成形术后的随访时长差异很大，从3个月到7年不等。在我们的队列中，绝大多数患者在术后14.5个月实现了超声稳定，并显示其初始肾积水分级有所改善。这也是诊断和纠正手术失败的时间范围。没有与实现稳定时间相关的临床或手术变量。文献中也报道了类似结果；然而，大多数研究将主要结局评估为解决情况而非肾积水的稳定情况。
超声稳定是确定单侧肾盂成形术后随访时长的合适且非侵入性参数，因为它是识别肾盂成形术失败、观察肾积水改善或稳定以及进行初次修复后所需任何额外手术的适当时间范围。
