Correlation of ultrasonographical findings of hydronephrosis/atrophy with 99m technetium-dimercaptosuccinic acid in childhood: A single-center experience from Turkey.

INTRODUCTION: To assess the association of frequently detected abnormalities (hydronephrosis and/or atrophy) on renal ultrasound with dimercaptosuccinic acid (DMSA) scan and the impact of vesicoureteral reflux (VUR) on these abnormalities to find new perspectives in pediatric age group. MATERIALS AND METHODS: We retrospectively reviewed the DMSA, ultrasonography (US), micturating cystourethrography (MCUG) findings, and medical records of pediatric patients with hydronephrosis and/or atrophy who were at follow-up between January 2013 and December 2016 in our center which is located in the southeast region of Turkey. RESULTS: Among 148 pediatric patients (male/female = 60/88), 66 had hydronephrosis, 72 had atrophy, and 10 patients had both. MCUG study detected VUR in 66 patients. Patients with atrophy were significantly older than patients with hydronephrosis (77.8 ± 58.6 vs. 39.3 ± 38.9 months, P = 0.002). Only 19.4% of our patients with atrophy had VUR. The rate of VUR was higher in the high-grade group than the mild-to-moderate-grade group although the difference was not statistically significant (80% vs. 61%, P = 0.199). Patients with high-grade hydronephrosis had more severe DMSA findings (73% vs. 39%). On the other side, 79% of the patients with high-grade VUR had severe DMSA findings. A total of 10 patients had both atrophy and hydronephrosis all affecting the left side. Six of them had VUR. Severe DMSA findings were more likely in toddlers (age 24-72 months) (48%). This finding was abruptly lowered after 72 months of age. CONCLUSIONS: The presence of atrophy and cases of left-sided hydronephrosis should be closely monitored, and DMSA may not be necessary in cases with high-grade hydronephrosis before MCUG.

Diuretic renography in hydronephrosis: a retrospective single-center study.

PURPOSE: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of hydronephrosis other than transient hydronephrosis. In children with unilateral hydronephrosis, mercaptoacetyltriglycine-3 diuretic renography (MAG3) is used to calculate differential renal function and to assess drainage. The aim of our study is to examine whether anteroposterior pelvic diameter on renal ultrasound (US) scan can predict both differential renal function (DFR) and obstruction in pediatric patients, and whether an US adequately identifies those patients who need further investigation. We also aimed to design a study with a larger sample size than previous studies investigating the relationship between MAG3 and US. METHODS: We retrospectively reviewed the MAG3, US, dimercaptosuccinic acid scan (DMSA) findings, and medical records of pediatric patients with hydronephrosis and/or atrophy who were at follow-up between January 2013 and December 2016 in our center which is located in the south-east region of Turkey. RESULTS: Two hundred and twenty-five pediatric patients (M/F = 156/69) with unilateral hydronephrosis but without VUR were enrolled in this study. The mean age of the children was 45.4 ± 48.3 months (range 2-173 months). Sixty-nine patients had obstructive pattern on 99mTc-MAG3. With respect to obstructive pattern, there was a significant difference between the hydronephrosis groups both with 15 and 20 mm border. An APD of greater than 20 mm had 15.8 times (95% CI 5.72-43.69) higher likelihood of having obstruction MAG3 findings. On the other hand, an APD of greater than 15 cm had 9.2 times (95% CI 3.01-28.57) higher likelihood of having obstruction MAG3 findings. The incidence of urinary tract infections was lower than in the obstructive group than the other groups. The regression analysis showed that an APD of greater than 20 mm was a risk factor for low DRF (OR = 5.208, 95% CI 1.529-17.743, p = 0.008). However, the regression analysis showed that an APD of greater than 15 mm was not a risk factor low DRF. CONCLUSIONS: The combination of ultrasound and MAG3 provides the necessary anatomical and functional information to follow the degree of obstruction and to decide between surgical intervention and conservative follow-up. Our study supports a threshold of 20 mm rather than 15 mm for severe obstruction and a low DRF. An APD threshold greater than 15 mm did not have a predictive value in DRF estimation.

[An easy, safe and affective method for the treatment of intussusception: ultrasound-guided hydrostatic reduction]. / Invajinasyonda kolay, güvenli ve etkili bir tedavi yöntemi: Ultrason esliginde hidrostatik redüksiyon.

BACKGROUND: Intussusception is one of the important causes of intestinal obstruction in children. Hydrostatic reduction under ultrasound guidance is a popular treatment method for intussusception. In the present study, we aimed to explain the demographic characteristics of and treatment approaches in patients diagnosed with intussusception by ultrasound. METHODS: Forty-one patients diagnosed with intussusception by ultrasound between August 2011 and May 2013 were retrospectively analyzed. Twenty-four of these patients who had no contraindications had been treated with ultrasound-guided hydrostatic reduction. RESULTS: Twenty-four of the patients were male and 17 were female, a 1.4/1 male-to-female ratio. The majority of the patients were between the ages of 6-24 months and 2-5 years. The mean age was 31.12±26.32 months (range 3-125). Patients were more frequently diagnosed in April and May. Seventeen patients who had clinical contraindications enrolled directly for surgery. In 20 of the 24 patients who underwent ultrasound-guided hydrostatic reduction, reduction was achieved. Three experienced recurrence. In two of these patients, successful reduction was achieved with the second attempt. The remaining patient was enrolled for surgery. Hydrostatic reduction was performed 26 times on these 24 patients, and in 22, success was achieved (84.6%). No procedure-related complications occurred in the patients. CONCLUSION: Ultrasound-guided hydrostatic reduction, with its high success rates and lack of radiation risk, should be the first choice therapeutic approach for children diagnosed with intussusception.