WOFAPS 2025 8th World Congress of Pediatric Surgery

Leily mohajerzadeh ¹, Ahmad Khaleghnejad Tabari ¹, Mohsen rouzrokh ¹, Mitra khalili ², nasrin Esfandyari ²

¹ pediatric surgery research center research institue for children health ,shahid beheshshti university of medical science Tehran Iran
² Shahid Beheshti University of Medical Sciences

Background: Newparameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior

diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement

in these ultrasonic parameters can prevent isotope scanning for a successful repair.

Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric

surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed

only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were

available before and after surgery.

Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 _ 37.44 months. The

mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 _ 2.07 mm. The mean

P/C ratio before surgery was 7.56 _ 4.38. The mean preoperative split renal function was documented at 42.23%. The mean followup

duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after

surgery was 6.72mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean

APD 6 months after surgery was 15.43mm. Themeankidney cortex diameter 6 months after surgery was 7.24mm. ThemeanP/C ratio

6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance halftime

in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD >

12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity,

and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus

DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1.

Conclusions: This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and

is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the

aforementioned parameter.