Indian Journal of Urology
LETTER TO EDITOR
Year
: 2022  |  Volume : 38  |  Issue : 4  |  Page : 328-

Author Reply Re: Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9


Gyanendra Ravindra Sharma, Anshu Gyanendra Sharma, Neha Gyanendra Sharma 
 Department of Urology, Chitale Clinic Private Limited, Solapur, Maharashtra, India

Correspondence Address:
Gyanendra Ravindra Sharma
Department of Urology, Chitale Clinic Private Limited, Solapur, Maharashtra
India




How to cite this article:
Sharma GR, Sharma AG, Sharma NG. Author Reply Re: Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9.Indian J Urol 2022;38:328-328


How to cite this URL:
Sharma GR, Sharma AG, Sharma NG. Author Reply Re: Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi-ureteric junction-like obstruction. Indian J Urol 2022;38:216-9. Indian J Urol [serial online] 2022 [cited 2023 Feb 4 ];38:328-328
Available from: https://www.indianjurol.com/text.asp?2022/38/4/328/357732


Full Text



Dear Sir,

We greatly appreciate the interest of the readers in our article.[1] We fully agree that a large multicenter trial is needed to establish the efficacy of normalized residual activity (NORA) and have mentioned this in our article. Whether NORA alone or along with t ½ or other parameter like cortical transit time can help to differentiate obstructed system from a dilated but nonobstructed system is still not clear.

The values of both NORA and t ½ suggest either good, partial, or poor drainage. The important question is do these drainage patterns suggest obstruction? Obstruction has been best defined by Koff as any impediment to urinary flow which, if left untreated, results in deterioration of renal function[2]. Going by this, the true evidence of obstruction is when there is loss of function. Hence, only those patients in whom the differential renal function fell below 40% were advised surgery and the drainage parameters suggested by NORA or t ½ were not taken into consideration for advising surgery. As mentioned above, only further studies will tell if these parameters help to predict the need for surgery in patients with prenatally detected presumed pelviureteric junction like obstruction.

During the follow-up of the 19 patients with t ½ values >20 min in whom surgery was not advised initially, none have needed surgery till date.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

References

1Sharma GR, Sharma AG, Sharma NG. Comparison of two drainage parameters on diuretic renogram in predicting the fate of prenatally detected pelvi – Ureteric junction - Like obstruction. Indian J Urol 2022;38:216-9.
2Koff SA. Problematic ureteropelvic junction obstruction. J Urol 1987;138:390.