Background

Dismembered pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). Although the frequency and timing of follow up imaging after pyeloplasty is variable, renal ultrasound (RUS) is commonly utilized. With minimal training, point-of-care ultrasound (POCUS) can be easily performed by a urologist during a post-operative visit.

Objective

Our hypothesis is that POCUS is an accurate, time-saving, and cost-effective alternative to a complete retroperitoneal ultrasound (CRUS) performed by the Radiology Department after pyeloplasty.

Study design

The clinical records of all children who underwent pyeloplasty (by any method) over a 12 month period at our institution were retrospectively reviewed. The exact timing and method (POCUS vs. CRUS) of follow up imaging was surgeon-dependent. Statistical analysis was performed to compare the time and cost of POCUS vs. CRUS. The clinical course of each patient who had each type of imaging was assessed.

Results

A total 45 patients were included in this analysis. Over a mean follow up period of 29 months, a total of 73 CRUS and 67 POCUS were performed. Each CRUS on average added 2 h to each patient's healthcare encounter. Had the 73 CRUS been performed as POCUS instead, this would have corresponded to $83,751 less charges to payers. There was no difference in the rate of the detection of worsening, stable, or improved hydronephrosis (HN) between either modality (p > 0.05). The recommended follow up time for observed HN was no different between CRUS and POCUS (p > 0.05). Children with worsening HN on POCUS underwent functional studies without confirmatory CRUS. Interestingly, two patients had metachronous, contralateral UPJO discovered during post-operative imaging. These were both discovered by POCUS.

Nineteen (42%) patients who had attended at least one post-operative visit were eventually loss to follow-up. This occurred exclusively in those who did not have worsening ultrasound (p < 0.01). There was no difference in the loss to follow-up after POCUS (8) or CRUS (12) (p > 0.05).

Conclusions

POCUS performed by a urologist is an accurate assessment of HN after pyeloplasty with time and cost savings to compared to a CRUS performed by a radiologist. POCUS is not associated with any difference in rate of detection of worsening HN or rate of loss to follow up.

Summary Table

背景

肢解性肾盂成形术被认为是输尿管盆腔连接梗阻（UPJO）的金标准治疗。尽管肾盂成形术后随访影像的频率和时间是可变的，但通常使用肾脏超声（RUS）。只需进行最少的培训，泌尿科医生就可以在术后访问期间轻松地进行即时护理超声（POCUS）。

目的

我们的假设是，POCUS可以替代放疗后放射科进行的完整腹膜后超声检查（CRUS），是一种准确，省时且经济高效的选择。

学习规划

回顾性地回顾了在我们机构进行了12个月的肾盂成形术（通过任何方法）的所有儿童的临床记录。随访成像的确切时机和方法（POCUS与CRUS）取决于外科医生。进行统计分析以比较POCUS与CRUS的时间和成本。评估了每种具有每种成像类型的患者的临床病程。

结果

该分析总共包括45名患者。在平均29个月的随访期间，共进行了73次CRUS和67次POCUS。每个CRUS平均使每个患者的医疗经历增加2小时。如果将73个CRUS作为POCUS进行，这将减少83,751美元的付款人费用。两种方式之间恶化，稳定或改善的肾积水（HN）的检出率均无差异（p  > 0.05）。推荐的观察HN随访时间在CRUS和POCUS之间无差异（p > 0.05）。在POCUS上HN恶化的儿童进行了功能性研究，未证实CRUS。有趣的是，两名患者在术后影像学检查中发现了异时的对侧UPJO。这些都是POCUS发现的。

至少接受过一次术后访视的19名患者（42％）最终失去了随访。这种情况仅发生在那些没有超声恶化的患者中（p  <0.01）。POCUS（8）或CRUS（12）后的随访损失无差异（p  > 0.05）。

结论

由泌尿科医师进行的POCUS是对肾盂成形术后HN的准确评估，与放射科医师进行的CRUS相比，可以节省时间和成本。POCUS与恶化的HN的检测率或随访的丢失率没有任何关系。

汇总表

图例* p  <0.05。