Predictive Factors of Contralateral Operation after Initial Pyeloplasty in Children with Antenatally Detected Bilateral Hydronephrosis Due to Ureteropelvic Junction Obstruction

Abstract

Objectives: This study was performed to analyze the predictive factors of a contralateral operation after initial pyeloplasty in patients with antenatally detected bilateral ureteropelvic junction obstruction. Methods: Patients with prenatally diagnosed bilateral ureteropelvic junction obstruction who underwent initial pyeloplasty (aged <12 months at initial pyeloplasty) were offered to participate in the study. Patients were recruited from January 2012 to December 2015. The anteroposterior renal pelvic diameter, parenchymal thickness, and calyceal dilatation were evaluated. Predictive factors of contralateral pyeloplasty after initial unilateral pyeloplasty were also examined. Results: In total, 82 patients were included in the study (mean age, 2.8 months). Among all patients who underwent initial pyeloplasty, additional contralateral pyeloplasty was required in 11 patients (13.4%). The outcome of contralateral hydronephrosis was assessed as resolution, persistence, or surgery. The median anteroposterior renal pelvic diameter and calyceal dilatation were significantly different among the groups (p < 0.001). Calyceal dilatation of ≥10 mm and a calyceal dilatation/parenchymal thickness ratio of ≥5 strongly suggested the likelihood of a contralateral operation. Conclusions: In most patients with bilateral ureteropelvic junction obstruction, improvement or resolution of contralateral hydronephrosis following initial unilateral pyeloplasty can be expected. Patients with contralateral calyceal dilatation >10 mm and the calyceal dilatation/parenchymal thickness ratio >5 are at higher risk of surgery.

Nephroureterectomy versus pyeloplasty for giant hydronephrosis in children with upper urinary tract obstruction; perspectives from a tertiary health facility in Southern Nigeria

“…12,13 Parameters from scintigraphy, diuresis renography and ultrasonography, like differential renal function, calyceal dilatation and calyceal dilatation/ parenchymal thickness ratio have been shown to guide management and assess outcome. 14,15 These assessment tools are more useful for cases seen early and in whom upper urinary tract damage can be minmised. [16][17][18] Detailed preoperative evaluation of children diagnosed early is able to predict those that will require surgery and give guidance to management.…”

Prenatal Diagnosis and Findings in Ureteropelvic Junction Type Hydronephrosis

“…Probability of postnatal surgery was 15% in cases where renal pelvis AP diameter was ≥15 mm (35). When calyx dilatation is ≥10 mm, spontaneous resolution is 37%, the possibility of persistence is 29% and the surgical requirement is around 33% (35). However, in cases where calyx dilatation was <5 mm and AP diameter was <10 mm, 90-100% regression was reported, and there is virtually no need for surgery (0-3.7%) (35).…”

“…Jiang et al reported a spontaneous regression rate of 61%, and persistence rate of 23% in cases diagnosed with antenatal bilateral UPJHN (35). Probability of postnatal surgery was 15% in cases where renal pelvis AP diameter was ≥15 mm (35).…”

“…Jiang et al reported a spontaneous regression rate of 61%, and persistence rate of 23% in cases diagnosed with antenatal bilateral UPJHN (35). Probability of postnatal surgery was 15% in cases where renal pelvis AP diameter was ≥15 mm (35). When calyx dilatation is ≥10 mm, spontaneous resolution is 37%, the possibility of persistence is 29% and the surgical requirement is around 33% (35).…”

“…When calyx dilatation is ≥10 mm, spontaneous resolution is 37%, the possibility of persistence is 29% and the surgical requirement is around 33% (35). However, in cases where calyx dilatation was <5 mm and AP diameter was <10 mm, 90-100% regression was reported, and there is virtually no need for surgery (0-3.7%) (35). This study has shown that pelvic AP diameter plays a primary role along with calyx dilation in determining the follow-up process and the need for intervention.…”