Postnatal management of antenatally diagnosed ureteropelvic junction obstruction

Ismail, A.; Elkholy, Amr; Zaghmout, O.; Alkadhi, A.; El-Naggar, Osama R; Khairat, A.; Elhassanat, H.; Mosleh, Ayman; Hamad, B.; Elzomer, J.; Elkaabi, A.

doi:10.1016/j.jpurol.2005.07.005

Cited by 22 publications

(18 citation statements)

References 11 publications

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“…Ismail and associates [7] reported their experience of 234 children with prenatally detected PUJ obstruction managed over a 13-year period but did not define the mean or median duration of follow up for this cohort of patients. These authors performed early pyeloplasty (predominantly for reduced differential function), in 52 children (22%), whilst 182 children were initially managed conservatively.…”

Section: Conservative Managementmentioning

confidence: 99%

Prenatal diagnosis: What do we know of long-term outcomes?

Thomas

2010

Journal of Pediatric Urology

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Section: Conservative Managementmentioning

confidence: 99%

Prenatal diagnosis: What do we know of long-term outcomes?

Thomas

2010

Journal of Pediatric Urology

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“…These two metrics have previously been described as potential indications for surgery, [16][17][18] although the thresholds for intervention remain controversial. [5][6][7]19 Observations by Ulman et al of more than 100 infants with unilateral, SFU 3/4 hydronephrosis was that an obstructed washout pattern (T½ > 20 minutes) occurred in more than half of children who were successfully followed non-operatively. Meanwhile, washout times less than 20 minutes did not eliminate the risk of obstruction requiring pyeloplasty.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with surgical intervention in children with high-grade congenital hydronephrosis

Chalmers

Siomos

Gilsdorf

et al. 2014

Journal of Clinical Urology

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Purpose: A lack of uniform guidelines regarding ureteropelvic junction obstruction may be associated with demographic variations in pyeloplasty timing. This study objective was to determine if children who undergo surgery are more likely to be of minority race. Materials and methods: Children with Society for Fetal Urology (SFU) 3-4 hydronephrosis were reviewed. Demographic and clinical characteristics were abstracted. Bivariable associations between clinical/demographic characteristics and pyeloplasty versus observation as well as follow-up findings were assessed with chi-square testing. The bivariable relationship between race and time from first clinic visit to surgery was evaluated by Kaplan-Meier curve. Multivariable logistic regression was performed to estimate the relationship between clinical characteristics and management decision. Results: Thirty-nine patients underwent pyeloplasty and 50 were observed. There were no differences in demographics, including race/ethnicity. Factors associated with surgery included higher SFU grade (p = 0.01), preoperative MAG3 (p = 0.02), and T½ >20 (p = 0.01). On multivariate analysis, MAG3 T½ >20 was associated with surgery (OR = 0.20, 95% CI: 0.07-0.61). Median time to surgery for whites versus non-whites was not significant (232 vs 208 days, p = 0.16). Conclusions: In our cohort, the decision to perform pyeloplasty is associated with clinical rather than demographic characteristics. Despite controversy regarding T½ interpretation, delayed radiotracer clearance remained a significant predictor of surgery.

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“…This high rate might have been due to the makeup of the study population, which included severe cases that even necessitated postnatal renal function tests. The factors used to determine whether surgery should be performed have typically been the renal pelvic diameter, 3 , 37 Society for Fetal Urology grade, 38 decrease in the differential renal function, 39 location, symptom severity, bilaterality, and age 38 , 40 . In this study, we primarily considered the Society for Fetal Urology grade determined from serial postnatal sonographic scans when deciding whether to perform surgical correction.…”

Section: Discussionmentioning

confidence: 99%

“…Renal function is an important parameter in decisions regarding postnatal management. Many studies have been done on the prenatal renal pelvic diameter and renal function, 2 as well as the decisive factors for surgery 3 ; however, few studies have focused on the relationship between renal volume, especially when measured by 3‐dimensional (3D) sonography, and renal function.…”

mentioning

confidence: 99%

Feasibility of Measuring 3-Dimensional Renal Parenchymal Volume to Predict Postnatal Renal Function in Near-Term Fetuses With Congenital Hydronephrosis

Nam¹,

Cho

Kwon³

et al. 2012

Journal of Ultrasound in Medicine

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A Preliminary Studyongenital urogenital diseases such as hydronephrosis, multicystic dysplastic kidneys, autosomal dominant and recessive polycystic kidneys, and renal duplication are often diagnosed using prenatal sonography. Fetal hydronephrosis is one of the most common, readily diagnosed renal abnormalities on prenatal sonography, which occurs in 1% to 4% of all pregnancies. 1,2 Renal function is an important parameter in decisions regarding postnatal management. Many studies have been done on the prenatal renal pelvic diameter and renal function, 2 as well as the decisive factors for surgery 3 ; however, few studies have focused on the relationship between renal volume, especially when measured by 3-dimensional (3D) sonography, and renal function. Nam, MD, Arthur Cho, MD, Ja Young Kwon, MD, PhD, Yong Won Park, MD, PhD, Young Han Kim, MD, PhD Received August 31, 2011, from Ka Hyun ORIGINAL RESEARCHObjectives-The purposes of this study were to evaluate the feasibility of predicting kidney function using the fetal renal parenchymal volume as determined by prenatal 3-dimensional (3D) sonography and to determine the association among the prenatal renal pelvic diameter, renal parenchymal volume, and postnatal renal function in nearterm fetuses with unilateral hydronephrosis.Methods-This retrospective study included 42 kidneys (21 normal and 21 hydronephrotic) from 21 fetuses between 30 and 39 weeks' gestation. We used the extended imaging virtual organ computer-aided analysis (XI VOCAL; 10 planes) technique for the prenatal volumetric measurements, and postnatal renal function was estimated using renal scintigraphy. An independent-samples Student t test, Spearman's rank correlation, and simple linear regression were used for the statistical analyses. Reproducibility was confirmed with a paired Student t test and intraclass correlation coefficients.Results-The renal pelvic diameter correlated well with the renal parenchymal volume Spearman ρ = 0.765; P < .001). The postnatal renal function correlated with the adjusted 3D renal parenchymal volume (Spearman ρ = -0.321; P = .043) but did not correlate with the prenatal renal pelvic diameter (Spearman ρ = -0.291; P = .062).Conclusions-This preliminary study showed that 3D renal parenchymal volume could be a coparameter for predicting postnatal renal function with the renal pelvic diameter. Further studies in a larger population are required to obtain robust results.

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Postnatal management of antenatally diagnosed ureteropelvic junction obstruction

Cited by 22 publications

References 11 publications

Prenatal diagnosis: What do we know of long-term outcomes?

Prenatal diagnosis: What do we know of long-term outcomes?

Factors associated with surgical intervention in children with high-grade congenital hydronephrosis

Feasibility of Measuring 3-Dimensional Renal Parenchymal Volume to Predict Postnatal Renal Function in Near-Term Fetuses With Congenital Hydronephrosis

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