Success of Pyeloplasty

Gyanendra Sharma

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Pyeloplasty is associated with a high success rate.

Also majority of these patients undergo further studies like USG & renogram so that the surgeon is sure that the pyeloplasty was a success

But the post op evaluation at times brings its own shares of questions

The Hydronephrosis persists
More often than not there is not much change in DRF on renogram
T 1/2 and drainage curves also often do not show a non obstructive pattern
In developing countries often the patient has no previous records and if the patient presents to a different clinician --couple of years after pyeloplasty and a USG is done for a non urological problem then the usual sonography report is moderate hydronephrosis suggestive of PUJ obstruction. We all must have come across this scenario when our old cases come back with report and it takes a good amount of counselling as regards convincing them that this is imprint hydronephrosis and not PUJ obstruction

So the question comes as to how do we assess a success of pyeloplasty

Improvement in DRF on renogram post pyeloplasty is without doubt a marker of success

But what about cases with scenarios as mentioned above in point no.4?

Can USG solve this dilemma

We had done a joint study with the dept. of pediatric radiology at Hong Kong using USG to predict the success of pyeloplasty

The criteria we follow is

AP Diameter of renal pelvis decreases by more than 10% in prone position is indicative of good drainage provided tha there is no substantial increase in calyceal dilatation in prone position
AP Diameter increases by > 10% in prone position or there is marked increase in calyceal dilatation in prone position --this suggests poor drainage and should be evaluated by renogram
Anything that falls inbetween the above two parameters is suggestive of partial/ indeterminate drainage and should be followed by with USG & renogram

We have found this policy very useful especially in cases with H/O pyeloplasty and no previous records available

This write up is to invite more thoughts and comments from all on this topic of success of pyeloplasty

I am attaching our article on the same for the kind perusal of all those who are interested

View Document

Comments(4)

Tikenjit Mazumdar
11 May 2020 02:02:56 PM

Thank u sir..itâ€™s an excellent article...however I have one question to ask u..In situation 1 2 n 3...could we use CTT for increasing sensitivity of renogram because USG is still subjective test everywhere skilled sonologist services rdiffcult to obtain..
Gyanendra Sharma
14 May 2020 10:18:28 PM

Good though Tikenjit
If CTT improves then it logically suggests ood drainage
If CTT deteriorates then possibility of failed pyeloplasty is there
What if CTT remins the same > 3 minutes but pre & post pyeloplasty same values--then the dilemma persists and further follow up is needed

Another question--How long should one follow these patients after pyeloplasty?
Dr. Roy Chally
15 May 2020 04:47:48 PM

3 false positive in 43 in the paper. Proof that this is not good enough to follow.
AP diameter of pelvis Measurement is subjected to many variables to correlate with function.
Ramesh Babu
19 May 2020 09:35:23 PM

We have proposed a hydronephrosis severity score only to address this issue. It combines renographic and sonographic criteria so that better comparison can be made. At least if one parameter improves scores improves. Please go through the article in Journal of Pediatric Urology titled " Hydronephrosis severity score: an objective assessment of hydronephrosis severity in children"