LOWER MOIETY HEMINEPHROURETERECTOMY IN THE DUPLEX REFLUXING KIDNEY - THE ACCURACY OF ISOTOPIC SCINTIGRAPHY IN FUNCTIONAL ASSESSMENT

Objective To determine the accuracy of dimercaptosuccinic acid (DMSA) scintigraphy in assessing the differential function between upper and lower moieties of a refluxing duplex system. Patients and methods Betw een 1990 and 1996, 20 patients underwent lower moiety heminephroureter ectomy. All patients had their differential renal function assessed by DMSA scintigraphy before and after surgery, the results being assesse d by comparing the predicted and actual loss of renal function. Result s The mean (SD, range) function attributed to the scarred lower moiety (predicted loss of function) was 4.3 (4.9, 0-14)%, which compared wit h an actual mean loss of function of 6.8 (5.1, +4 to -16)%. Thus the m ean (SD, range) difference between the predicted and actual loss of re nal function was -2.1 (3.2, +4 to -8)%. Conclusion DMSA scintigraphy p rovides accurate assessment of the differential renal function between upper and lower moieties in a duplex system. The decision to proceed to lower moiety heminephroureterectomy can be logically based on the i nformation gained from DMSA scintigraphy.