Can we improve the usefulness of the diuretic renogram in the diagnosis of ureteropelvic junction obstruction (UPJO) in children? Introduction of mercaptoacetyltriglycine-suspected obstruction scoring system (MAG-SOS).

Autor: Hodhod A; Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada. Electronic address: amrwuk@yahoo.co.uk., Fermin-Risso C; Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada., Farhad M; Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada., Cook AJ; Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada., Aburezq J; Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada., Eid H; Pediatric Radiology, Montreal Children's Hospital, Montreal, QC, Canada., Weber BA; Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2023 Jun; Vol. 19 (3), pp. 311.e1-311.e8. Date of Electronic Publication: 2023 Mar 02.
DOI: 10.1016/j.jpurol.2023.02.022
Abstrakt: Introduction: Mercaptoacetyltriglycine (MAG-3) renogram is one of the gold standard diagnostic tools of ureteropelvic junction obstruction (UPJO); however, there is no widely agreed indications of pyeloplasty based on MAG-3 findings. In this study, we introduce a renogram scoring system that can help improve the prognostic value of MAG-3 renogram and in the decision making of pyeloplasty.
Patients and Methods: We retrospectively reviewed consecutive pyeloplasties for antenatal hydronephrosis from 2010 to 2020. A control group was included of non-operatively managed SFU grade 3 and 4. The initial renal ultrasound and preoperative MAG-3 Lasix renogram were reviewed for differential renal function (DRF), type of renogram curve and tracer washout half-time (T 1/2 ). A ROC curve was used to evaluate the cut-off points that can be associated with obstruction. A multivariate linear regression model was used to assess the best renogram parameter that can predict surgical intervention.
Results: We included 188 patients with 209 renal units. The median age for pyeloplasty was 5.4 months. The mercaptoacetyltriglycine-Suspected Obstruction Scoring System (MAG-SOS) was associated with pyeloplasty (AUC = 0.97, P < 0.001) (Figure A). A score of 5 is 100% specific for obstruction. 78% of units required surgical intervention had a MAG-SOS score of≥5 while all units of the control group had a range of score 0-4. Using the multivariate analysis, the MAG-SOS system showed to the only independent predictor for pyeloplasty (HR = 0.03, p < 0.001).
Discussion: This study has some limitations. Firstly, the retrospective nature of the cohort; however, all patients were reviewed by one investigator who was blinded to the line of management. This is a single institutional study; therefor, this MAG-SOS should be evaluated by other centers to ensure its efficiency. Lastly, the pyeloplasty decision was taken by 3 different urologists; nevertheless, all of them adopt the same indications which are similar to those of the Society for Pediatric Urology and the Canadian Urological Association guidelines.
Conclusion: The MAG-SOS system showed to be a useful tool that can predict pyeloplasty. A score of 5 has 100% specificity for patients having a pyeloplasty performed. Prospective studies are required to confirm the usefulness of this novel tool.
(Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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