BERKELEY, CA (UroToday.com) - This study by Taha, et al examined the role of voided urine endothelin-1 in the diagnosis and follow-up of children with ureteropelvic junction obstruction. The study included 35 children with unilateral ureteropelvic junction obstruction who underwent pyeloplasty and 30 control children. These controlled children included 10 healthy children, 10 with vesicoureteral reflux and 10 with renal stones. The group collected voided urine samples from the children in the study group before surgery and from the renal pelvis by needle aspiration during pyeloplasty. Bladder urine samples were also collected from the study group 1, 2, 3, 6, 9 and 12 months postoperatively. The bladder urine samples were also collected from all 30 control children. The endothelin-1 level was measured in the urine samples collected from the entire cohort.

The group found that preoperative endothelin-1 levels in the voided urine of the study group were significantly greater than the levels in each of the 3 control groups. For the entire study, a cutoff of 3 fmol/mg creatinine gave a sensitivity of 74.3% and a specificity of 90% with an overall accuracy of 81.5%. In 8 children (1 year of age or younger), a cutoff value of 4 fmol/mg creatinine gave a sensitivity and specificity of 100%. The group also found that when they compared with the preoperative value, endothelin-1 had decreased significantly 1 year after pyeloplasty.

The group concluded that the endothelin-1 level in voided urine is a useful marker that could be used as a noninvasive tool for the diagnosis and long term follow-up of children with ureteropelvic junction obstruction. Further investigation should help elucidate if this would be a reproducible modality to follow children with ureteropelvic junction obstruction. The noninvasiveness is quite intriguing.

Mohamed A. Taha, Ahmed A. Shokeir, Hussein G. Osman, Abd El-Aziz. Abd El-Aziz, Sami E. Farahat.

Urology 69(3) 560-564, March 2007

UroToday.com Pediatric Urology Section

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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