title: National Trends in Followup Imaging after Pyeloplasty in Children in the United States.
abstract: OBJECTIVE
  Radiographic followup after pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric pyeloplasty.
  
  
  METHODS
  Using the MarketScan® database, we identified patients 0 to 18 years old undergoing pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns.
  
  
  RESULTS
  We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6 months postoperatively 853 patients (91%) underwent at least 1 imaging study and 192 (24%) underwent renography. Within the first 12 months postoperatively 91% of patients underwent at least 1 imaging study, most commonly ultrasound. After 12 months almost a third of the patients were not followed with imaging. Of the 71% undergoing imaging most underwent ultrasound. Younger age and female gender were independently associated with frequent imaging (at least yearly) on multivariate logistic regression.
  
  
  CONCLUSIONS
  Following pediatric pyeloplasty there is variation in modality and frequency of imaging followup. The majority of patients are followed with renal ultrasound, with less frequent use of functional imaging. Almost a third of patients do not undergo followup imaging after 1 year.
authors: Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington. Electronic address: rshsi@uw.edu.
authors: Ryan S
authors: RS
authors: Hsi
authors: Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
authors: Sarah K
authors: SK
authors: Holt
authors: Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
authors: John L
authors: JL
authors: Gore
authors: Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
authors: Thomas S
authors: TS
authors: Lendvay
authors: Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
authors: Jonathan D
authors: JD
authors: Harper
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D003950:Diagnostic Techniques, Urological / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000601:surgery; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000601:surgery*; D011182:Postoperative Care; D014481:United States; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: diagnostic imaging; hydronephrosis; kidney; pediatrics; ureteral obstruction