Pd44-09 Defining Success in Pyeloplasty Patients to Guide Initial Postoperative Followup

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) II (PD44)1 May 2024PD44-09 DEFINING SUCCESS IN PYELOPLASTY PATIENTS TO GUIDE INITIAL POSTOPERATIVE FOLLOWUP Jane R. Kielhofner, Jonathan Song, Jason (Zhiyu) Qian, Catherine Gu, William R. Boysen, Steven L. Chang, Douglas Dahl, Jairam Eswara, George Haleblian, Anton Wintner, and Daniel Wollin Jane R. KielhofnerJane R. Kielhofner , Jonathan SongJonathan Song , Jason (Zhiyu) QianJason (Zhiyu) Qian , Catherine GuCatherine Gu , William R. BoysenWilliam R. Boysen , Steven L. ChangSteven L. Chang , Douglas DahlDouglas Dahl , Jairam EswaraJairam Eswara , George HaleblianGeorge Haleblian , Anton WintnerAnton Wintner , and Daniel WollinDaniel Wollin View All Author Informationhttps://doi.org/10.1097/01.JU.0001008800.83683.92.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteropelvic junction obstruction (UPJO) often undergo pyeloplasty to address reduction of kidney function or bothersome symptoms. However, guidelines and literature lack clear definitions of operative success. Here we evaluate the key factors of composite pyeloplasty success in a group of 216 patients treated at a multi-institution hospital system from 2015-2023. These factors include improvement in flank pain, split function change, improved T½ on nuclear scan, stable or reduced hydronephrosis, avoidance of reoperation, and creatinine improvement. Our aim is to identify the components that strongly indicate overall pyeloplasty success to guide more focused future postoperative assessments. METHODS: Composite success variable was defined according to Figure 1. Patients were stratified by outcome and univariate analysis was performed using T-test and chi-square tests to identify significant differences. We then analyzed the ability for individual positive outcomes to predict overall composite success by comparing weighted F1 scores. F1 scores are the harmonic mean of precision and recall, and weighting accounts for uneven distribution of outcomes. RESULTS: Of 216 adults aged 18-85 who underwent pyeloplasty for treatment of UPJO, 176 (81.5%) adults were considered to have a positive composite outcome based on the decision flowchart. Of the variables assessed, all individual outcomes were significantly associated with success (p≤0.02) except T½. Improving flank pain (F1=0.81), hydronephrosis (F1=0.78), and no re-operation (F1=0.81) were the most predictive for success. CONCLUSIONS: These results suggest that when patients present with flank pain and hydronephrosis, improvement of these findings may be the most appropriate measure of operative success in patients who did not undergo reoperation. These data also suggest that information derived from renal scan has limited predictive power of operative success 3-6 months post surgery and may be deferred in straightforward cases to minimize unnecessary imaging. Future efforts would be directed towards increasing our study population and increasing demographic diversity to further assess our definition of success; in addition, a prospective trial looking at the utility of renal scan in a postoperative setting may be beneficial. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e908 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jane R. Kielhofner More articles by this author Jonathan Song More articles by this author Jason (Zhiyu) Qian More articles by this author Catherine Gu More articles by this author William R. Boysen More articles by this author Steven L. Chang More articles by this author Douglas Dahl More articles by this author Jairam Eswara More articles by this author George Haleblian More articles by this author Anton Wintner More articles by this author Daniel Wollin More articles by this author Expand All Advertisement PDF downloadLoading ...