Presented at the 13th Annual Meeting of European Society for Paediatric Urology, Budapest, Hungary, April 2002.
The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles
Article first published online: 16 APR 2003
Volume 91, Issue 7, pages 678–682, May 2003
How to Cite
Bolduc, S., Upadhyay, J., Restrepo, R., Sherman, C., Farhat, W., Bägli, D.J., McLorie, G.A., Khoury, A.E. and El Ghoneimi, A. (2003), The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles. BJU International, 91: 678–682. doi: 10.1046/j.1464-410X.2003.04247.x
- Issue published online: 16 APR 2003
- Article first published online: 16 APR 2003
- Accepted for publication 27 January 2003
- duplex kidney;
- upper pole nephrectomy;
- histology and diagnostic imaging
To compare the diagnostic imaging findings with the histological lesions in upper pole nephrectomy (UPN) specimens of duplex system ureteroceles, using renal ultrasonography (US) and nuclear renal scintigraphy.
PATIENTS AND METHODS
Between 1992 and 2000, 86 patients with a ureterocele in a duplex system underwent surgery. The results from US were reviewed in 84 patients by a radiologist, for echogenicity, parenchymal thinning and hydronephrosis; 77 nuclear renal scans describing the differential function of the upper poles were also reviewed. Fifty-five patients underwent UPN (25 antenatal, 30 postnatal; 18 intravesical, 37 extravesical) and the specimens were available for independent review by a pathologist, describing five histological categories, i.e. chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Histological lesions were categorized as severe (> 25%) or minimal (≤ 25%). Radiological features and the histology of UPN were then analysed, and correlated using Fisher's exact test and multivariate analysis.
Severe histological lesions were reported in 38 specimens (69%) and minimal lesions in 17 UPN specimens (31%). Severe parenchymal thinning was associated with a severe pathological lesion (P < 0.02). There was no correlation with the echogenicity or degree of hydronephrosis. Dysplasia, found in 64% of specimens, did not correlate with increased echogenicity. Minimally functioning upper poles on nuclear renal scan (≤ 4% overall function) were significantly associated with severe histological lesions (P = 0.01). There was no correlation between diagnostic imaging features and the mode of presentation or type of ureterocele.
Multivariate analysis, severe parenchymal thinning on renal US and minimal function on nuclear renal scan can be used to predict the severity of histological lesions of the upper pole. These results may be helpful in the making therapeutic decisions for patients with ureteroceles in duplex systems.