Predictive value of diuretic renal scintigraphy after pyeloplasty in children with ureteropelvic junction obstruction / 中华核医学与分子影像杂志

ABSTRACT

Objective:To identify factors of diuretic renography for predicting the therapeutic effect in management of children with ureteropelvic junction obstruction (UPJO) after Anderson-Hynes pyeloplasty.Methods:Between January 2016 and January 2020, 170 children (136 males and 34 females, age (57.3±51.8) months; UPJO of 130 in left and 40 in right) who were diagnosed as UPJO by diuretic renography and followed up for more than twice in Beijing Friendship Hospital were retrospectively collected. Patients′ information including age, gender, symptoms, affected side, types of operation, pre and post diuretic renography and urinary ultrasound, duration of clinical follow-up were collected. Patients were divided into improvement group and no change/deterioration group according to the comprehensive evaluation indicators including postoperative follow-up, urinary ultrasound and diuretic renography. Clinical characteristics of 2 groups were compared by using independent-sample t test and χ2 test. Predictors of therapeutic effect after Anderson-Hynes pyeloplasty were analyzed by logistic regression analysis and receiver operating characteristic (ROC) curves of independent prognostic factors were further constructed. Results:After pyeloplasty in 170 children of UPJO, they were divided into improvement group ( n=131) and no change/deterioration group ( n=39). The differential renal fraction (DRF) and response to furosemide stimulation (RFS) before pyeloplasty were significantly different between 2 groups ( t=-2.083, χ2=12.870, both P<0.05). Age (odds ratio ( OR)=1.272, 95% CI 1.015-1.537), DRF ( OR=12.584, 95% CI 1.119-24.543) and RFS ( OR=11.727, 95% CI 2.263-60.780) before pyeloplasty were related to the therapeutic effect of UPJO children after pyeloplasty (all P<0.05). Multivariate logistic analysis identified DRF ( OR=9.770, 95% CI 1.800-19.356) and RFS ( OR=10.599, 95% CI 2.012-55.830) before pyeloplasty were independent predictors of therapeutic effect of UPJO children after pyeloplasty (both P<0.05). DRF and RFS combination predicted efficacy with a sensitivity of 85.7%(96/112), specificity of 63.8%(37/58), and area under curve of 0.735 (95% CI 0.66-0.80). Conclusion:DRF and RFS after pyeloplasty, which reflecting renal function and upper urinary tract drainage, are important for the timing of surgery and postoperative outcome evaluation in children with UPJO.