Hydronephrosis severity score: an objective assessment of hydronephrosis severity in children—a preliminary report

Babu, Ramesh; Venkatachalapathy, Easwaramoorthy; Sai, Venkata

doi:10.1016/j.jpurol.2018.09.020

Cited by 24 publications

(20 citation statements)

References 18 publications

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“…It has been developed to determine the predictivity of pyeloplasty based on ultrasound and diuretic renogram findings (34). The crucial problem and disadvantage of HSS is that it relies on diuretic renogram and its curve.…”

Section: Surgical Indications For Upjhn Based On the Hydronephrosis Smentioning

confidence: 99%

Grading of Hydronephrosis: An Ongoing Challenge

Önen

2020

Front. Pediatr.

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The crucial point for prompt diagnostics, ideal therapeutic approach, and follow-up of hydronephrosis associated with UPJ anomalies in children is the severity of hydronephrosis. Such many hydronephrosis grading systems as AP diameter, SFU, radiology, UTD, and Onen have been developed to evaluate hydronephrosis severity in infants. Unfortunately, it is still an ongoing challenge and there is no consensus between different disciplines. AP diameter is a very dynamic parameter and is affected by many factors (hydration, bladder filling, position, respiration). More importantly, its measurement is very variable and misleading due to different renal pelvic configurations. The radiology grading system has the same grades 1, 2, and 3 as the SFU grading system with addition of the AP diameter for the first 3 grades. This grading system divides parenchymal loss into two different grades. Grade 4 represents mild parenchymal loss while grade 5 suggests severe parenchymal loss. However, it is operator dependent, is not decisive, and does not differentiate grades 4 and 5 clearly. All grades of SFU are very variable between operators and clinicians. UTD classification aims to put all significant abnormal urinary findings together including the kidney, ureter, and bladder and thus determines the risk level for infants with any urinary disease. Different renal deterioration risks occur depending on the mechanism of hydronephrosis. Therefore, SFU and UTD classification may result in significant confusion and misleading in determining the severity of hydronephrosis. SFU-4 and UTD-P3 represent a considerable range of severity of hydronephrosis. Both represent minimal thinning of the medullary parenchyma and severe thinning of the cortical parenchyma (cyst-like hydronephrotic kidneys) at the same grade. The wide definition of SFU-4 and UTD-P3 fails to indicate accurately the severity of hydronephrosis and thus significantly misleads from a prompt treatment. They do not suggest who need surgical treatment and who can safely be followed non-operatively. The anatomy and physiology of the 4 suborgans of the kidney (renal pelvis, calices, medulla, and cortex) are completely different from each other. Therefore, each part of the kidney affect and behave differently as a response to UPJ-type hydronephrosis (UPJHN) depending on the severity of hydronephrosis. The upgraded Onen hydronephrosis grading system has been developed based on this basic evidence both for prenatal and post-natal periods. The Onen grading system determines specific detailed findings of significant renal damage, which clearly show and suggest who can safely be followed conservatively from who will need surgical intervention for UPJHN. Neither AP diameter nor radiology, SFU, or UTD classification is the gold standard in determining the severity of hydronephrosis. All these grading systems are based on subjective parameters Onen Grade of Hydronephrosis: An Ongoing Challenge and are affected by many factors. They do not determine the exact severity of UPJHN and thus cause...

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Section: Surgical Indications For Upjhn Based On the Hydronephrosis Smentioning

confidence: 99%

Grading of Hydronephrosis: An Ongoing Challenge

Önen

2020

Front. Pediatr.

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“…Other scoring systems, such as the Hydronephrosis Severity Score (HSS) developed by Babu et al attempted to predict pyeloplasty using ultrasound and diuretic renogram results ( 27 ). The main limitation of the HSS is that it relies greatly on the diuretic renogram and the interpretation of its curve, all factors which are heavily exam and operator dependent.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Based Scoring System for Indication of Pyeloplasty in Patients With UPJO-Like Hydronephrosis

McGrath

Farrokhyar

et al. 2020

Front. Pediatr.

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Background: Previous scoring systems have used renal scan parameters to assess severity of ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN), however this information is not always reliable due to protocol variation across centers and renogram limitations. Therefore, we sought to evaluate the Pyeloplasty Prediction Score (PPS), which utilizes only baseline ultrasound measurements to predict the likelihood of pyeloplasty in infants with UPJO-like. Methods: PPS was developed using three ultrasound parameters, Society of Fetal Urology (SFU) grade, transverse anteroposterior (APD), and the absolute percentage difference of ipsilateral and contralateral renal lengths at baseline. PPS was evaluated using prospectively collected prenatal hydronephrosis data ( n = 928) of patients with UPJO-HN. Children with vesicoureteral reflux. primary megaureter, other associated anomalies, bilateral HN and <3 months of follow-up were excluded. Scores were analyzed regarding its usefulness in predicting which patients would be more likely to undergo pyeloplasty. Sensitivity, specificity, likelihood ratios (LR) and receiver operating characteristic (ROC) curve were determined. Results: Of 353 patients, 275 (78%) were male, 268 (76%) had left UPJO-like HN, and 81 (23%) had a pyeloplasty. The median age at baseline was 3 months (IQR 1–5). The PPS system was highly accurate in distinguishing patients who underwent pyeloplasty using baseline ultrasound measurements (AUC: 0.902). PPS of 7 and 8 were found to have a sensitivity of 85 and 78%, and specificity of 81 and 90%, respectively. PPS of 8 was associated with a LR of 7.8, indicating that these patients were eight times more likely to undergo pyeloplasty. Conclusion: Overall, PPS could detect patients more likely to undergo pyeloplasty using baseline ultrasound measurements. Those with a PPS of eight or higher were eight times more likely to undergo pyeloplasty.

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“…In our center, according to the literature [9], we evaluate our patients after 1, 3, 6 and 12 months after surgery. Renal scan with MAG3 is performed in selected cases depending on ultrasonic (persistence of pelvic dilatation and/or worsening of echotexture) and clinical (persistent symptoms after surgery) data [7].…”

Section: Methodsmentioning

confidence: 99%

“…Since 2005, the gold standard approach for hydronephrosis in children younger than 2 years in our institution is the One-Trocar Assisted Pyeloplasty (OTAP) [6]. This procedure combines the advantages of a minimally invasive technique with the high success rate of standard dismembered pyeloplasty [7]. We have treated very young patients affected by severe forms of hydronephrosis for which an early surgical correction can be of some advantage.…”

Section: Introductionmentioning

confidence: 99%

Feasibility, in terms of efficacy and safety, of video-assisted pyeloplasty (OTAP) in the first 90 days of life

et al. 2019

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Introduction The uretero-pelvic junction (UPJ) is the most common site of obstruction in the pediatric upper urinary tract, causing hydronephrosis. In our institution, the gold standard approach for hydronephrosis in infants is the One-Trocar-Assisted Pyeloplasty (OTAP). The aim of this study is to evaluate the feasibility of OTAP in terms of efficacy and safety in the first 90 days of life. Methods We retrospectively reviewed all charts and long-term follow-up of 138 infants treated with OTAP; we selected and examined the ones with a defined diagnosis of severe UJPO and, thus, treated in the first 90 days of life: 28 patients. Indications for early surgery were: antero-posterior pelvic diameter (APD) > 20 mm and an obstructive pattern on renography; impaired echotexture and/or relative renal function < 40% had to be associated. Results Out of 23 patients, we witnessed one conversion to open surgery (4.35%) and one recurrence (4.35%) of UPJO. The mean pre-surgery APD was 35.2 mm, while the mean post-surgery APD was 17.32 mm. The mean operative time was 133 min. The mean hospitalization time was 7.71 days. The mean average of follow-up was 46.41 months (minimum 1 year). Conclusions Our experience suggests that OTAP is a valid and feasible technique in terms of safety and efficacy for the early treatment of very young infants affected by UPJO.

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Hydronephrosis severity score: an objective assessment of hydronephrosis severity in children—a preliminary report

Cited by 24 publications

References 18 publications

Grading of Hydronephrosis: An Ongoing Challenge

Grading of Hydronephrosis: An Ongoing Challenge

Ultrasound-Based Scoring System for Indication of Pyeloplasty in Patients With UPJO-Like Hydronephrosis

Feasibility, in terms of efficacy and safety, of video-assisted pyeloplasty (OTAP) in the first 90 days of life

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