Sage Journals: Discover world-class research

Abstract

Background

This study examines the correlation between magnetic resonance imaging (MRI)-derived volume parameters, surgical outcomes, and renal function in adults undergoing ureteropelvic junction (UPJ) obstruction surgery. Understanding these relationships can improve surgical planning, patient selection, and postoperative prognosis.

Purpose

To assess the correlation between anatomical parameters and surgical outcomes in adult patients with UPJ obstruction.

Material and Methods

A prospective cross-sectional study was conducted on 60 patients with UPJ obstruction, selected via simple random sampling. The hydronephrosis volume (HV) to renal volume (RV) ratio was calculated using MR urography (MRU). Preoperative diethylene triamine pentaacetic acid (DTPA) differential renal function (DRF) and creatinine levels were also recorded. Patients requiring surgery were followed up after 6 months, measuring pelvis/RV ratio, creatinine, and DTPA DRF. Statistical analyses were performed to find correlations.

Results

Operated patients had a higher preoperative HV/RV ratio (AUC=0.914, 95% confidence interval [CI]=0.829–1.000; P <0.001) and higher DTPA DRF values (AUC=0.936, 95% CI=0.860–1.000; P <0.001). Patients with greater preoperative HV/RV ratios were less likely to achieve anatomical normalization. Significant correlations were found between HV/RV ratios with DTPA DRF and creatinine (P <0.05). DeLong’s test showed no significant differences between HV/RV ratios and DTPA DRF in predicting surgical need.

Conclusion

Quantitative volumetric analysis using MRU can effectively predict the need for surgery and renal function deterioration in patients with UPJ obstruction. The HV/RV ratio plays a crucial role in guiding surgical decisions and predicting outcomes. This study emphasizes and tests the hypothesis that higher degree of hydronephrosis correlates with higher degree of deterioration of renal function and need for surgical intervention.

Keywords

Hydronephrosis volume magnetic resonance urography renal volume renal function ureteropelvic junction obstruction

Get full access to this article

View all access options for this article.

References

Kandur

Salan

Guler

, et al. Diuretic renography in hydronephrosis: a retrospective single-center study. Int Urol Nephrol 2018;50:1199–1204.

Jacobson

Flink

Johnson

, et al. The correlation between serial ultrasound and diuretic renography in children with severe unilateral hydronephrosis. J Urol 2018;200:440–447.

Khan

Ahmed

Lee

, et al. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol 2014;11:629–638.

Oberlin

McGuire

Pilecki

, et al. Contemporary national surgical outcomes in the treatment of ureteropelvic junction obstruction. Urology 2015;85:363–367.

Jacobs

Lai

Seelam

, et al. Urologic Diseases in America Project. The comparative effectiveness of treatments for ureteropelvic junction obstruction. Urology 2018;111:72–77.

Bai

Hou

Zhang

, et al. Ability of volume measures of hydronephrosis to predict need for surgery and evaluate renal function in children with ureteropelvic junction obstruction. Int J Urol 2021;29:235–241.

Zhang

Sun

Chen

, et al. Ultrasound evaluation for prediction of outcomes and surgical decision in fetal hydronephrosis. Exp Ther Med 2019;18:1399–1406.

Cerrolaza

Grisan

Safdar

, et al. Quantification of kidneys from 3D ultrasound in pediatric hydronephrosis. Annu Int Conf IEEE Eng Med Biol Soc 2015;2015:157–160.

Ucar

Kurugoglu

. Urinary ultrasound and other imaging for ureteropelvic junction type hydronephrosis (UPJHN). Front Pediatr 2020;8:546.

10.

Sinha

Bagga

Krishna

, et al. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol 2013;23:83–97.

11.

Chipde

Gambhir

HLS

kumar

, et al. Factors predicting improvement of renal function after pyeloplasty in pediatric patients: a prospective study J. Urol 2012: 262–265.

12.

Mahmoud

Salem Morsy

Ali Morsy

HAE

, et al. Predictors of surgical intervention for antenatally detected Ureteropelvic Junction Obstruction (UPJO): a prospective multivariate analysis. Urologia 2024;91:220–225.

13.

Kelley

White

Goetz

, et al. Sonographic renal parenchymal measurements for the evaluation and management of ureteropelvic junction obstruction in children. Front Pediatr 2016;4:42.

14.

Houbois

Haneder

Merkt

, et al.

Can computed tomography volumetry of the renal cortex replace MAG3-scintigraphy in all patients for determining split renal function?

Eur J Radiol 2018;103:105–111.

15.

Ortapamuk

Naldoken

Tekdogan

, et al. Differentia renal function in the prediction of recovery in adult obstructed kidneys after pyeloplasty. Ann Nucl Med 2003;17:663–668.

16.

Rickard

Lorenzo

Braga

. Renal parenchyma to hydronephrosis area ratio (PHAR) as a predictor of future surgical intervention for infants with high-grade prenatal hydronephrosis. Urology 2017;101:85–89.

17.

Luyckx

Brenner

. The clinical importance of nephron mass. J Am Soc Nephrol 2010;21:898–910.

18.

Mitsui

Sadahira

Araki

, et al. The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy. Clin Exp Nephrol 2018;22:453–458.

19.

Christensen

Lundgren

Stenvinkel

, et al. Renal volumetry with magnetic resonance imaging. Acta Radiol Open 2017;6:205846011773112.

Correlation of radiological volume parameters using magnetic resonance imaging with surgical intervention,postoperative outcome,and renal function in adult patients of pelvic ureteric junction obstruction