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EDITORIAL COMMENT
Year : 2016  |  Volume : 32  |  Issue : 3  |  Page : 227-228
 

Comment on: Kumar et al. Follow-up imaging after pediatric pyeloplasty. Indian J Urol, 2016;32:221-226


Department of Pediatric Surgery, Pediatric Urology and MAS, Rainbow Children's Hospitals, Hyderabad, Telangana, India

Date of Web Publication1-Jul-2016

Correspondence Address:
V.V.S. Chandrasekharam
Rainbow Children's Hospitals, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.185094

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How to cite this article:
Chandrasekharam V. Comment on: Kumar et al. Follow-up imaging after pediatric pyeloplasty. Indian J Urol, 2016;32:221-226. Indian J Urol 2016;32:227-8

How to cite this URL:
Chandrasekharam V. Comment on: Kumar et al. Follow-up imaging after pediatric pyeloplasty. Indian J Urol, 2016;32:221-226. Indian J Urol [serial online] 2016 [cited 2019 Sep 22];32:227-8. Available from: http://www.indianjurol.com/text.asp?2016/32/3/227/185094


Pyeloplasty is one of the common operations in pediatric urologic practice. However, there is no clear consensus on the follow-up of children after pyeloplasty: What tests, when, how many times, and for how long? These are the questions that need to be answered. There are two main reasons for follow-up testing: To confirm the success of pyeloplasty and to assess the function of the operated kidney. Ultrasound (USG) examinations, 3–6 months after surgery, are considered sufficient for follow-up, especially to ascertain the success of the operation.[1] A recent survey in the United States has shown that USG is the most common, and in many cases, the only test used for postpyeloplasty follow-up in children.[2] In kidneys with initial impaired function, a postoperative diuretic renogram (DR) may be obtained at a later date. Long ago, we demonstrated that kidney function after successful pyeloplasty continued to improve up to 1 year and then reached a plateau, without any further improvement at 5-year follow-up.[3] Thus, if a DR is done after pyeloplasty, it may be better to delay it till 1 year.

The authors of this paper tried to answer these very questions about post-pyeloplasty follow-up. They should be congratulated for the excellent follow-up of a large number of children after pyeloplasty. They performed multiple DR studies post-pyeloplasty. The only problem is that DR in children requires intravenous cannulation and bladder catheterization (for a well-tempered study) and definitely poses some risk of radiation to the child. I agree with the authors that a single post-operative DR is sufficient.

The authors seem to rely more on DR than on USG for follow-up. The reasons cited are that USG is operator-dependent, and reducing the size of the dilated pelvis would influence the validity of post-operative USG. Conversely, one could argue that pelvic reduction during routine pyeloplasty is unnecessary,[4],[5],[6] and standard grading of hydronephrosis would ensure good inter- and intra-observer validity.[7],[8] Most importantly, the first postoperative USG could be used as a baseline for further follow-up. Thus, one cannot completely do away with USG for post-pyeloplasty follow-up; in kidneys with good pre-operative function, USG may be the only test required for follow-up. In our practice, we perform a USG 3 months after pyeloplasty, followed by DR at about 1 year after the surgery, to allow for assessment of maximal functional improvement of the operated kidney.[9] Further follow-up is continued with yearly USG only.

Finally, I wish that all surgeons develop a strict follow-up protocol for their patients so that many more good scientific papers can be published from the subcontinent in future.

 
   References Top

1.
Romao RL, Farhat WA, Pippi Salle JL, Braga LH, Figueroa V, Bägli DJ, et al. Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction. J Urol 2012;188:2347-53.  Back to cited text no. 1
    
2.
Hsi RS, Holt SK, Gore JL, Lendvay TS, Harper JD. National trends in followup imaging after pyeloplasty in children in the United States. J Urol 2015;194:777-82.  Back to cited text no. 2
    
3.
Chandrasekharam VV, Srinivas M, Bal CS, Gupta AK, Agarwala S, Mitra DK, et al. Functional outcome after pyeloplasty for unilateral symptomatic hydronephrosis. Pediatr Surg Int 2001;17:524-7.  Back to cited text no. 3
    
4.
Morsi HA, Mursi K, Abdelaziz AY, Elsheemy MS, Salah M, Eissa MA. Renal pelvis reduction during dismembered pyeloplasty: Is it necessary? J Pediatr Urol 2013;9:303-6.  Back to cited text no. 4
    
5.
Kajbafzadeh AM, Tourchi A, Nezami BG, Khakpour M, Mousavian AA, Talab SS. Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants. J Pediatr Urol 2011;7:283-8.  Back to cited text no. 5
    
6.
Burgu B, Suer E, Aydogdu O, Soygur T. Pelvic reduction during pyeloplasty for antenatal hydronephrosis: Does it affect outcome in ultrasound and nuclear scan postoperatively? Urology 2010;76:169-74.  Back to cited text no. 6
    
7.
Kim SY, Kim MJ, Yoon CS, Lee MS, Han KH, Lee MJ. Comparison of the reliability of two hydronephrosis grading systems: The society for foetal Urology grading system vs. the Onen grading system. Clin Radiol 2013;68:e484-90.  Back to cited text no. 7
    
8.
Vemulakonda VM, Wilcox DT, Torok MR, Hou A, Campbell JB, Kempe A. Inter-rater reliability of postnatal ultrasound interpretation in infants with congenital hydronephrosis. Int Urol Nephrol 2015;47:1457-61.  Back to cited text no. 8
    
9.
Chandrasekharam VVS. Laparoscopic pyeloplasty in infants: Single-surgeon experience. J Pediatr Urol 2015;11:272.e1-5.  Back to cited text no. 9
    




 

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