Contribution of Dynamic Renal Scintigraphy with ^99mTc-DTPA in the Management of Pyeloureteral Junction Syndrome in Senegal: Study of 88 Cases in the Nuclear Medicine Department of Idrissa Pouye General Hospital (Dakar)

Introduction: Pyeloureteral junction syndrome is the most common of the congenital obstructive uropathies. Her annual impact is evaluated at 5 for 100,000 in the general population in Senegal. Its frequency ranged from 1 to 10 across 5000 births. Dynamic renal scintigraphy (DRS) with hyperdiuresis testing has two aims: to define the impact of urinary tract obstruction on renal function and to assess the severity of the obstruction and the flow of the urine. Our objective was to evaluate the role of dynamic renal scintigraphy in the management of ureteropelvic junction obstruction (UPJO) in Senegal. Methods: This was a retrospective study based on the records of patients with UPJO who underwent DRS with 99mTc-DTPA at the nuclear medicine service of HOGIP, from 2010 to 2017. Results: We had collected 88 files of obstructive uropathies, the UPJO were represented in 51 cases (57.96%). The average age of discovery was 37.5 years for adults and 5.5 years for children. Male predominance was also generally found among the children who lived in the house of the adults. The circumstances of discovery were represented by clinical signs in the large majority of cases, with a predominance of abdominal pain, followed by signs of urinary infection. The paraclinical exams most commonly used for the diagnosis, management, and monitoring of these pathologies include ultrasound of the urinary pathways, urinary tract tests, CT urography, and dynamic isotope scans. Ultrasound had a 78% permit to diagnose a UPJO in 43% of patients. The CT urogram revealed dilation of the calyceal cavities in 98.18% of patients. The intake Treatment was dominated by surgical intervention, taking into account the results by DRS. The data of their dynamic renal scintigraphy with ^99mTc-DTPA yielded the following results: The Tmax was prolonged in 59.80%; the NORA had shown drainage partial drainage in 25.49% and poor drainage in 19.61%; the VFR of both kidneys was abnormal in 43.14% of which 50% are hypofunctional and 50% mute; the obstruction was of organic origin in 49.02%, of functional origin in 41.18% and normal in 9.80% after the post-void test. Conclusion: Renal scintigraphy with ^99mTc-DTPA and a furosemide challenge has made it possible to overcome the limitations of morphological imaging techniques in distinguishing organic obstruction from functional impairment, thus contributing to a better grasp of charge therapy with a favorable dosimetric profile.