Page 15 - CUA 2020_Pediatric

2020 CUA Abstracts

Conclusions: UD >4 mm is associated with a higher incidence of FUTI units had T 1/2 <5 minutes and none had T1/2 >75 minutes (p<0.001). The
and surgeries when compared to UD ≤ 4mm. Within P2, there is no ROC curve for T1/2 <5 minutes demonstrated 98 % sensitivity and 51%
significant difference in surgical intervention or FUTI when comparing specificity, whereas a T1/2 >75 minutes demonstrated 100% specificity
UD 4.1–7 mm and >7 mm This leads us to believe that UD >4 mm is a and 26% sensitivity. Analysis of the GW using a ROC curve revealed that a
reliable cutoff to define ureteral dilation. cutoff of 50% GW has 100% specificity and 55% sensitivity for pyeloplasty.
Conclusions: The modified T1/2 criteria are valid predictors of pyeloplasty
MP-12.5 for AHN. Unfortunately, these criteria exist in only 25% of patients. In the
remaining 75% of cases, those with indeterminant T1/2, the GW <50%
Validation of modified diuretic drainage times cutoffs in was helpful in identifying a further 30% of cases requiring pyeloplasty.
antenatal hydronephrosis
Amr Hodhod , Francis Petrella , Mohamed El-Sherbiny , Iman Sadri ,
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Roman Jednak , J.-P. Capolicchio 1 MP-12.6
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1 Urology, McGill University Health Centre, Montreal, QC, Canada Outcomes of Deflux treatment for vesicoureteral reflux
Introduction: The value of diuretic renography drainage times in congeni- following pediatric transplant: A systematic review
tal hydronephrosis (AHN) decision-making is controversial. Recently, the Karla Rebullar , Fardod O’Kelly , Martin A. Koyle , Andrew J Kirsch ,
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Washington group suggested a modification to the classically described Armando J. Lorenzo , Rusul Al-Kutbi , Fadi Zu’bi
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diuretic drainage time cutoffs. They found that a drainage half-time (T1/2) 1 Division of Urology, The Hospital for Sick Children, Toronto, ON,
<5 minutes is normal whereas a T1/2 exceeded 75 minutes predicts pyelo- Canada; Department of Pediatric Urology, Children’s Healthcare of
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plasty. We sought to evaluate these criteria, and in addition, we investi- Atlanta, Atlanta, GA, United States
gated the use of global tracer washout (GW) as a predictor of pyeloplasty. Introduction: Vesicoureteral reflux (VUR) after renal transplant in the
Methods: We retrospectively reviewed consecutive pyeloplasties from pediatric population may be associated with an increased incidence of
2004–2018 for AHN. Patients who underwent pyeloplasty due to low urinary tract infection (UTIs) leading to increased morbidity. The non-
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differential renal function (DRF) <30% or infection were excluded. The orthotopic location of the transplanted ureter may pose challenges in cor-
control group comprised grade 3 and 4 AHN managed conservatively. recting the VUR using endoscopic injection techniques. Herein, we report
The initial renal ultrasound and MAG 3 Lasix renogram were reviewed the results of a systematic review evaluating the outcomes of endoscopic
for SFU grade, DRF, type of renogram curve, T1/2, and GW. A ROC curve treatment of VUR using Deflux in this population.
was used to evaluate the T1/2 and GW cutoff points that can predict Methods: PubMed and Embase databases were searched from October
pyeloplasty, using a p<0.05. 2001 to April 2019. Full-text English articles involving patients less than
Results: The pyeloplasty group consisted of 84 patients (88 renal units) and 18 years old at the time of transplant, with a diagnosis of VUR post-
the control group consisted of 58 patients (59 renal units). The median transplantation, who underwent Deflux treatment were included.
age at pyeloplasty was 4.5 months (0.5–26), while the median followup Results: We found six eligible studies describing Deflux treatment out-
of the control group was 19 months (9–43). One renal unit (1.1%) in the comes in 67 pediatric patients with post-transplant VUR where voiding
pyeloplasty group had a T1/2 <5 minutes, whereas 26% (23/88) had T 1/2 cystourethrogram (VCUG) confirmed the diagnosis and resolution of VUR.
>75 minutes (p<0.001) (Table 1). In the control group, 48% (28/59) of Mean success rate was 36.8%. Ureteral obstruction occurred in seven
MP-12.5. Table 1. Patients’ demographics and initial renogram data
Pyeloplasty group Control group p
Patients number (units) 84 (88) 58 (59)
Age at presentation median (range) 0.37 mon (0.03–10.9) 0.83 mon (0.07–9.5) 0.002
Gender Male n (%) 63 (75) 45 (77.6) 0.72
Female n (%) 21 (25) 13 (22.4)
Side Male n (%) 63 (75) 45 (77.6) 0.25
Female n (%) 21 (25) 13 (22.4)
Laterality Unilateral n (%) 80 (95.2) 57 (98.3) 0.7
Bilateral n (%) 4 (4.8) 1(1.7)
SFU at presentation Grade 3 n (%) 25 (28.4) 42 (71.2) <0.001
Grade 4 n (%) 63 (71.6) 17 (28.8)
Age at renogram median (range) 1.7 mon (0.3–11) 2.8 mon (0.8–25.2) 0.001
DRF median (range) 46 % (30–100) 51% (34–65) 0.001
T half median (range) 30.5 min (3.3–500) 5.4 min (0–51.4) <0.001
Global washout median (range) 46% (0–95) 85% (54–99.4) <0.001
T half according to Washington criteria
<5minutes n (%) 1 (1.1) 28 (47.5) <0.001
5–75 minutes n (%) 64 (72.7) 31 (52.5)
>75 minutes n (%) 23 (26.2) 0
Global isotope washout
<50%, n (%) 47 (53.4) 0 <0.001
50–90%, n (%) 40 (45.5) 39 (66.1)
>90%, n (%) 1 (1.1) 20 (33.9)

S152 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)