Reza Khorramirouz

1. URINARY CARBOHYDARTE ANTIGEN 19-9 MAY PREDICT FAILURE OF NON-
OPERATIVE MANAGEMENT IN CHILDREN WITH URETEROPELVIC JUNCTION
OBSTRUCTION
ABDOL-MOHAMMAD KAJBAFZADEH1, REZA KHORRAMIROUZ1, ERFAN AMINI2,
ASAL HOJJAT1, FARHAD PISHGAR2, BEHNAM NABAVIZADEH1
1) Pediatric Urology and Regenerative Medicine Research Center, Pediatric Center of
Excellence, Tehran University of Medical Sciences, Tehran, Iran
2) Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Introduction: Surgical intervention is indicated in children with ureteropelvic junction
obstruction (UPJO) with deteriorating renal function. Determining predicting factors is of great
value in identifying kidneys which might benefit from early surgical intervention. We conducted
this study to assess the role of urinary carbohydrate antigen 19-9 (CA19-9) measurement in
determining optimal management of children with UPJO.
Patients and Methods: The patients were divided into three groups: Patients in group 1 required
immediate pyeloplasty. Group 2 were suitable for observation; however due to the deterioration
of condition pyeloplasty was indicated after a period of observation. Group 3 consisted of
patients who were considered for non-operative management with improvement of the condition
during the course of follow up.
Results: A total of 124 children (127 affected kidneys) with UPJO and median age of 4.7
months were considered in this study. 39 patients (31.5%) underwent pyeloplasty (group 1),

2. whereas 85 patients were considered for non-operative management. Crossover from observation
to pyeloplasty was necessary in 28 patients out of 85 (32.9%) patients (group 2) and the
remaining 57 patients showed significant improvement in APD. Mean urinary CA19-9 level was
224.6±232.5, 134.4±89.3 and 37.0±37.5 in group 1, 2 and 3 patients, respectively. ROC curve
analysis revealed that urinary CA19-9 level at cut off value of 25 has 93% sensitivity and 50%
specificity in predicting failure of non-operative treatment. Multivariate analysis showed that
both CA19-9 and APD were independent predictors of need for surgery.
Conclusion: Higher urinary CA19-9 level is associated with failure of non-operative
management in patients with UPJO.