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Park K, Kim K, Im YJ. Role of urinary N-acetyl-beta-D-glucosaminidase in predicting the prognosis of antenatal hydronephrosis. Investig Clin Urol 2024; 65:293-299. [PMID: 38714520 PMCID: PMC11076795 DOI: 10.4111/icu.20240091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE Urinary biomarkers are known to be able to diagnose renal damage caused by obstruction at an early stage. We evaluated the usefulness of urine N-acetyl-beta-D-glucosaminidase (NAG) to determine the prognosis of antenatal hydronephrosis. MATERIALS AND METHODS From January 2019 to December 2021, a retrospective study was performed on patients with grade 3 or 4 hydronephrosis. We analyzed the ultrasonographic findings and the urinary NAG/Cr ratio between the laparoscopic pyeloplasty (LP) group and active surveillance (AS) group. RESULTS A total of 21 children underwent LP for ureteropelvic junction (UPJ) obstruction and 14 children underwent AS. The mean age at the time of examination was 3.7 months (1.7-7.5 months) in the LP and 5.2 months (0.5-21.5 months) in the AS (p=0.564). The mean anteroposterior pelvic diameter was 30.0 mm (15.0-49.0 mm) in the LP and 16.7 mm (9.0-31.3 mm) in the AS (p=0.003). The mean renal parenchymal thickness was 2.6 mm (1.2-3.7 mm) in the LP and 3.8 mm (2.9-5.5 mm) in the AS (p=0.017). The urinary NAG/Cr ratio was 26.1 IU/g (9.8-47.4 IU/g) in the LP and 11.1 IU/g (2.6-18.1 IU/g) in the AS (p=0.003). After LP, the urinary NAG/Cr ratio was significantly reduced to 10.4 IU/g (3.4-14.2 IU/g) (p=0.023). CONCLUSIONS The urinary NAG/Cr ratio, one of the biomarkers of acute renal injury, is closely related to the degree of hydronephrosis. Therefore, it may be useful to determine whether to perform surgery on the UPJ obstruction and to predict the prognosis.
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Affiliation(s)
- Kwanjin Park
- Department of Pediatric Urology, Seoul National University Children's Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyeong Kim
- Department of Pediatric Urology, Seoul National University Children's Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jae Im
- Department of Pediatric Urology, Seoul National University Children's Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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Robinson EJ, Bayne A. Pyeloplasty may reverse the effect of growth delay from ureteropelvic junction obstruction in infants. Int Urol Nephrol 2024; 56:1227-1233. [PMID: 37991603 DOI: 10.1007/s11255-023-03870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty. METHODS We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6-16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6-16 months later. Interval changes in group height and weight percentiles are compared for significant changes. RESULTS The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11-27) and weight (6.0 percentiles; 95% CI 0.50-12) after intervention. CONCLUSIONS Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6-16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants.
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Affiliation(s)
- Eric J Robinson
- Department of Urology, Kaiser Permanente, Los Angeles, CA, USA.
| | - Aaron Bayne
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
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Randhawa H, Jones C, McGrath M, Braga LH. Non-refluxing Primary Megaureter in Children Resolves From Proximal to Distal. Urology 2023; 182:225-230. [PMID: 37776954 DOI: 10.1016/j.urology.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To evaluate a population of children with non-refluxing primary megaureter (NRPM), we investigated spontaneous resolution of ureteral dilation and the pattern (proximal to distal or distal to proximal) in which it occurs. METHODS From our prospectively collected prenatal hydronephrosis (HN) database (0-24 months, 2008-2017), selecting those with NRPM (n = 92). We excluded patients who underwent surgery (n = 20), children with <6 months follow-up (n = 2) and without a voiding cystourethrogram (VCUG) (n = 4). Images were segregated into 198 ureteric segments (proximal/mid/distal). We defined resolution as Society for Fetal Urology (SFU) (0/1), anteroposterior diameter (APD) <10 mm, and ureteric dilatation <5 mm. Descriptive statistics and Kaplan-Meier curves were created for time-to-resolution analyses. RESULTS Of 66 patients and 198 ureteral segments, median age at presentation was 2 months (0-12), 83% were male (33% circumcised). Mean APD at baseline was 11 ± 4 mm, and 79% had (SFU 3/4) HN. Mean dilatation of ureteral segments (mm) at baseline was: 9 ± 2 proximal, 9 ± 2 mid, and 11 ± 3 distal. At a median follow-up time of 26 (7-83) months, dilation of 55 (83%) proximal, 48 (72%) mid, and 22 (33%) distal ureteric segments had resolved. Overall, HN resolution occurred in 76% of patients. Resolution rates were similar for proximal/mid-ureters (83% vs 72%; P = .20); however, they were significantly different from distal segments (83% proximal vs 33% distal; 72% mid vs 33% distal, P <.01). CONCLUSION Our data suggest that spontaneous resolution of NRPM follows a proximal to distal progression. Distal ureteric dilatation takes up to 10 months longer to resolve compared to that of proximal and mid-ureteric segments, as well as that of the renal pelvis.
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Affiliation(s)
- Harkanwal Randhawa
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Conor Jones
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- Division of Pediatric Urology, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Luis H Braga
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Urology, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada; Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
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Hester AG, Krill A, Shalaby-Rana E, Rushton HG. Initial observational management of hydronephrosis in infants with reduced differential renal function and non-obstructive drainage parameters. J Pediatr Urol 2022; 18:661.e1-661.e6. [PMID: 35989171 DOI: 10.1016/j.jpurol.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/03/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Hydronephrosis secondary to ureteropelvic junction (UPJ) obstruction is a common finding in infants with prenatally-diagnosed hydronephrosis and often results in pyeloplasty due to obstructive drainage parameters and/or renal function compromise. However, little is known regarding the natural history of hydronephrosis with reduced differential renal function (DRF) but non-obstructive drainage. OBJECTIVE We sought to explore our experience with initial observational management of these patients. STUDY DESIGN A retrospective review of our institutional database of all diuretic MAG-3 renal scans obtained between 2000 and 2016 was performed. We included patients with antenatally-detected unilateral hydronephrosis ≥ SFU grade 2, first MAG-3 scan prior to 18months of age, DRF <40% and post-furosemide half-time (T1/2) <20 min. Exclusion criteria were: hydroureter, VUR, solitary kidney, duplication anomalies. Outcomes of interest were a progression of T1/2 ≥ 20 min and/or further decline in DRF >5%. RESULTS Of 704 patients with unilateral hydronephrosis, 91 had DRF≤40%, of which 29 (18 boys, 11 girls) met our inclusion criteria and were followed for a mean of 2.8 years (1.4 months-6.6 years). Mean age at first sonogram was 2.3 months. 2 patients had SFU grade 2, 16 had grade 3, and 9 had grade 4 hydronephrosis, and 2 unknown grade. Median half-time on initial MAG-3 scan across all patients was 10 min (3-20 min). Initial MAG3 scan was performed at a median of 2.3 months of age (0.3-17 months). 22/29 patients had >1 MAG3 scan. Of the 7 remaining, 5 were lost to follow-up and 2 demonstrated improvement in hydronephrosis. Worsening drainage occurred in 10/22(45%), median final T1/2 was 45.5 min 8 of these underwent pyeloplasty and 2 were lost to follow up. 4/22 patients (18%) had progressive decline in DRF (mean 8.3%, range 6-10%). 3/4 maintained non-obstructive drainage patterns and stable/improved hydronephrosis, and 1 underwent pyeloplasty. 13/18 remaining patients had stable DRF and 5 had improvement in DRF. 7(39%) of these underwent surgery for worsening drainage (Summary Figure). Overall, 7/29(24%) patients had sufficient resolution of hydronephrosis to be discharged from our care, 8(28%) are under continued observation, 9(31%) underwent pyeloplasty, and 5(17%) were lost to follow-up. In the observational group [median follow-up 4.5 years (3.7-6.6 years)], all 8 demonstrated improved non-obstructive drainage (T1/2 <20 minutes) and/or improvement in hydronephrosis. 4/10(40%) with DRF <35% underwent pyeloplasty versus 5/19(26%) with DRF 35-40%(p=0.67). CONCLUSION Initial observational management of unilateral hydronephrosis with reduced DRF and nonobstructive drainage is recommended as most kidneys maintain nonobstructive drainage and do not demonstrate further decline in DRF. Even when DRF decreases, the majority remain non-obstructive. Worsening drainage over time more often leads to the decision for pyeloplasty rather than change in DRF.
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Affiliation(s)
- Austin G Hester
- Division of Urology, Children's National Medical Center, Washington, DC, USA.
| | - Aaron Krill
- Division of Urology, Children's National Medical Center, Washington, DC, USA
| | - Eglal Shalaby-Rana
- Department of Radiology, Children's National Medical Center, Washington, DC, USA
| | - H Gil Rushton
- Division of Urology, Children's National Medical Center, Washington, DC, USA
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Green CA, Adams JC, Goodnight WH, Odibo AO, Bromley B, Jelovsek JE, Stamilio DM, Venkatesh KK. Frequency and prediction of persistent urinary tract dilation in third trimester and postnatal urinary tract dilation in infants following diagnosis in second trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:522-531. [PMID: 34369632 DOI: 10.1002/uog.23758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the frequency, associated characteristics and prognostic value of the current risk stratification system for prenatal urinary tract dilation (UTD) for predicting persistent UTD in the third trimester and subsequent postnatal UTD in the infant, following diagnosis in the second trimester. METHODS This was a single-institution retrospective cohort study of singleton pregnancies diagnosed with unilateral or bilateral UTD in the second trimester (before 28 weeks' gestation) with follow-up in the third trimester (at or after 28 weeks) between January 2017 and May 2019. In all cases, the prenatal diagnosis and stratification to low-risk (Grade A1) or increased-risk (Grade A2-3) UTD was made using the 2014 UTD consensus classification system. The primary outcomes included persistent prenatal UTD in the third trimester and postnatal UTD up to 6 months of age. We performed multivariable analysis to assess whether patient and second- and third-trimester sonographic characteristics (such as UTD laterality, other renal abnormality (calyceal dilation, abnormal parenchymal appearance, abnormal ureter or bladder) and anteroposterior renal pelvic diameter (AP-RPD)) were associated with the study outcomes. We assessed the predictive value of the current risk stratification system (Grade A1 vs Grade A2-3) in the second and third trimesters for persistent prenatal UTD and postnatal UTD using the area under the receiver-operating-characteristics curve (AUC). RESULTS Of 26 620 second-trimester ultrasound assessments in the study period, 347 patients were diagnosed with UTD in the second trimester and had third-trimester follow-up, of whom 150/347 (43% (95% CI, 38-49%)) had persistent UTD in the third trimester. Among the 282/347 (81%) patients with postnatal follow-up available, the frequency of postnatal UTD was 49/282 (17% (95% CI, 13-22%)), and among the subset with persistent UTD in the third trimester, the frequency of postnatal UTD was 46/102 (45% (95% CI, 35-55%)). The most frequent postnatal diagnosis was transient UTD (76%), followed by duplicated collecting system (10%). Of infants originally diagnosed with UTD in the second trimester, 2% (7/347) required surgery; stated differently, of the 49 infants with postnatal UTD, 14% (7/49) required surgery. At second-trimester diagnosis, sonographic predictors of both persistent prenatal UTD and postnatal UTD included the presence of other renal abnormality and UTD Grade A2-3. At third-trimester follow-up, predictors of postnatal UTD were larger mean AP-RPD and UTD Grade A2-3, while all cases had other renal abnormality. Second-trimester diagnosis of UTD Grade A2-3 had satisfactory discrimination for predicting persistent prenatal UTD (AUC, 0.64 (95% CI, 0.58-0.70)) and postnatal UTD (AUC, 0.72 (95% CI, 0.63-0.81)), as did third-trimester UTD Grade A2-3 for predicting postnatal UTD (AUC, 0.66 (95% CI, 0.56-0.76)). CONCLUSIONS The majority of cases of prenatal UTD did not result in postnatal UTD, and of those that did, very few required surgery. Follow-up third-trimester assessment after a second-trimester diagnosis of UTD is warranted. The current risk stratification system by UTD grade, based on the 2014 UTD consensus classification, can be used to predict postnatal UTD with fair accuracy. Further research is needed to determine whether the predictive performance of this system can be improved by incorporating additional risk factors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - J C Adams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - W H Goodnight
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - A O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - B Bromley
- Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital and Diagnostic Ultrasound Associates, Boston, MA, USA
| | - J E Jelovsek
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - D M Stamilio
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC, USA
| | - K K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
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Sharma GR, Panda A, Sharma AG. Renal cortical transit time in the evaluation of prenatally detected presumed pelvi ureteric junction like obstruction: A systematic review. Indian J Urol 2021; 37:116-124. [PMID: 34103793 PMCID: PMC8173951 DOI: 10.4103/iju.iju_236_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/12/2020] [Accepted: 08/09/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Differentiating nonobstructive from obstructive dilatation of the kidney is a clinical dilemma in prenatally detected hydronephrosis. Many radionuclide renogram parameters have been used to differentiate obstructed from non-obstructed units, including cortical transit time (CTT). We evaluate the role of CTT in identifying obstruction through a systematic review. Methods A literature search of the MEDLINE, MEDLINE In-Process, and MEDLINE Epub Ahead of Print, EMBASE, Google scholar, Pub Med, and Cochrane Library was done using key words - radionuclide renogram, CTT, parenchymal transit time, cortical transit, renography to identify articles on the subject. The identified articles were assessed for appropriateness and reviewed. Results The initial search yielded a total of 1583 articles, after adding the articles from references and applying the inclusion and exclusion criteria a total of 28 articles were selected. CTT showed good inter observer agreement in identifying obstruction. The use of CTT as a single parameter for determining the need for surgery and to identify those kidneys which will have functional improvement after surgery has been evaluated and has been found to be useful. CTT is best used in conjunction with ultrasonography to make clinical decisions. Conclusion The commonly used visual method of estimating the CTT, is a promising parameter for the evaluation of prenatally detected pelviureteric junction obstruction. Further well-designed multicenter prospective studies are needed to establish it as the most specific parameter to differentiate obstructive from nonobstructive dilatation of the pelvicalyceal system.
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Affiliation(s)
| | - Arabind Panda
- Department of Urology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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ElSheemy MS. Postnatal management of children with antenatal hydronephrosis. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundPostnatal management of infants with antenatal hydronephrosis (ANH) is still one of the most controversial issues. The majority of infants with ANH are asymptomatic with only few children who develop renal insufficiency. Thus, the biggest challenge for pediatric urologists is to distinguish children who will require further investigations and possible intervention prior to the development of symptoms, complications or renal damage in a cost effective manner without exposing them to the hazards of unnecessary investigations.Main bodyIn this review article, literature on ANH were reviewed to present the current suggestions, recommendations, guidelines and their rational for postnatal management of ANH. It is agreed that a large portion of infants with ANH will improve; thus, the protocol of management is based mainly on observation and follow-up by ultrasound to detect either resolution, stabilization or worsening of hydronephrosis. The first 2 years of life are critical for this follow-up as the final picture is mostly reached during that period. Advanced imaging using voiding cystourethrography or renal scintigraphy are required for children at risk. Then, surgical intervention is selected only for a subgroup of these infants who showed worsening of hydronephrosis or renal function.ConclusionsThe protocol of management is based mainly on observation and follow-up by US to detect either resolution, stabilization or worsening of hydronephrosis. Postnatal evaluation should be performed for any neonate with a history ANH at any stage during pregnancy even if it was resolved during third trimester. Exclusion of UTI should be performed by urinalysis for all cases followed by urine culture if indicated. Serum creatinine should be performed especially in patients with bilateral ANH. US is the initial standard diagnostic imaging technique. Other imaging modalities like VCUG and nuclear renal scans may be required according to the results of the US evaluation. The most important items in decision making are the presence of bilateral or unilateral hydronephrosis, presence or absence of hydroureter, presence of lower urinary tract obstruction and degree of hydronephrosis on the initial postnatal US. Then an intervention is selected only for a subgroup of these patients who showed deterioration in renal function or degree of hydronephrosis or were complicated by UTIs. All these recommendations are based on the available literature. However, management of ANH is still a controversial issue due to lack of high evidence-based recommendations. Randomised controlled studies are still needed to provide a high level evidence for different aspects of management.
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Leigh J, Rickard M, Sanger S, Petropoulos J, Braga LH, Chanchlani R. Antibiotic prophylaxis for prevention of urinary tract infections in the first year of life in children with vesicoureteral reflux diagnosed in the workup of antenatal hydronephrosis: a systematic review. Pediatr Nephrol 2020; 35:1639-1646. [PMID: 32350666 DOI: 10.1007/s00467-020-04568-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/28/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Children with antenatal hydronephrosis (ANH) diagnosed with postnatal asymptomatic vesicoureteral reflux (VUR) are thought to be at higher risk of urinary tract infection (UTI). As such, continuous antibiotic prophylaxis (CAP) is empirically recommended until age of toilet training; however, there are limited data to support this. The objective of this systematic review was to summarize the existing data and compare UTI rates in infants with asymptomatic VUR on CAP during the first year of life, to those not on CAP. Secondary objectives were to determine associated risk factors with UTI development. METHODS A systematic search of all relevant studies and abstracts was conducted using 4 electronic databases by utilizing appropriate key words by an expert hospital librarian. Eligible studies included children with prenatal hydronephrosis, asymptomatic VUR with or without CAP, and reported on development of UTI in the first year. RESULTS Of 6903 citations screened, 18 were selected, giving a total population of 829 (69.4% male, median age 57 days) who met the inclusion criteria. Most studies were retrospective and of low-quality evidence. Overall, 15.4% of patients developed at least one breakthrough UTI and females had a higher risk of UTI (odds ratio (OR) 2.3, 95% CI 1.1-4.7). Comparison with children not taking CAP was not readily reported, and meta-analysis could not be completed. CONCLUSIONS Randomized controlled trials and standardized reporting of clinical variables are required to understand the protective effect of antibiotic prophylaxis in this cohort.
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Affiliation(s)
- Jennifer Leigh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Mandy Rickard
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Luis H Braga
- Department of Pediatric Urology, McMaster Children's Hospital, Hamilton, Canada
| | - Rahul Chanchlani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada.
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Schaeffer AJ, Cartwright PC, Lau GA, Ebert MD, Fino NF, Nkoy FL, Hess R. Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life. Adv Urol 2020; 2020:2108362. [PMID: 32802050 PMCID: PMC7414334 DOI: 10.1155/2020/2108362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The workup and surveillance strategies for infant hydronephrosis (HN) vary, although this could be due to grade-dependent differences in imaging intensity. We aimed to describe the frequency of imaging studies for HN within the first year of life, stratified by initial HN grade, within a large regional healthcare system. Study Design and Data Source. Retrospective cohort using Intermountain Healthcare Data Warehouse. Inclusion criteria: (1) birth between 1/1/2005 and 12/31/2013, (2) CPT code for HN, and (3) ultrasound (U/S) confirmed HN within four months of birth. Data Collection. Grade of HN on initial postnatal U/S; number of HN-associated radiologic studies (renal U/Ss, voiding cystourethrograms (VCUGs), and diuretic renal scans); demographic and medical variables. Primary Outcome. Sum of radiologic studies within the first year of life or prior to pyeloplasty. Statistical Analysis. Multivariate poisson regression to analyze association between the primary outcome and the initial HN grade. RESULTS Of 1,380 subjects (993 males and 387 females), 990 (72%), 230 (17%), and 160 (12%) had mild, moderate, and severe HN, respectively. Compared with those with mild HN, patients with moderate (RR: 1.57; 95% CI: 1.42-1.73) and severe (RR: 2.09; 95% CI: 1.88-2.32) HN had a significantly higher rate of imaging use over 12 months (or prior to surgery) after controlling for potential confounders. CONCLUSIONS In a large regional healthcare system, imaging use for HN is proportional to its initial grade. This suggests that within our system, clinicians treating this condition are using a risk-stratified approach to imaging.
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Affiliation(s)
- Anthony J. Schaeffer
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Patrick C. Cartwright
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Glen A. Lau
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Mark D. Ebert
- Intermountain Pediatric Imaging SLC, UT/Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Nora F. Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Flory L. Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rachel Hess
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Ključevšek T, Pirnovar V, Ključevšek D. Percutaneous Nephrostomy in the Neonatal Period: Indications, Complications, and Outcome-A Single Centre Experience. Cardiovasc Intervent Radiol 2020; 43:1323-1328. [PMID: 32462222 DOI: 10.1007/s00270-020-02528-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the indications, technique for percutaneous nephrostomy (PCN) insertion, the complications related to PCN, duration of PCN, and outcome following PCN removal regarding the kidney function. MATERIAL AND METHODS Medical charts of 31 neonates (22 boys and 9 girls, mean age 13.9 days) treated with 43 PCN were reviewed. Collected data included indications for PCN, PCN complications, duration of PCN, and outcome of these patients by analysing the kidney function. RESULTS The indications for PCN insertion were obstructive urinary tract dilation in 24 neonates (four with associated infection), and non-obstructive urinary tract dilation with urosepsis or pyonephrosis in seven cases. Primary technical success of PCN placement using Seldinger technique was 97.7%. The following complications were reported: self-limited post-procedural bleeding into the pelvicalyceal system in two, chronic microscopic haematuria in five, and clinically manifested urinary tract infection in five children. Four PCN were dislocated. Cellulitis was present at the skin entry of 5 PCN, urinary leak in 5 PCN, and mechanical damage of 5 PCN. Eight PCN had to be replaced. Mean duration of PCN was 5 months. Kidney insufficiency was detected in 5/29 children with the mean follow-up of 3.9 years. CONCLUSIONS PCN is a safe, effective transient solution in neonates with pyonephrosis or when surgery of obstructed urinary system has to be postponed. The rate of minor complications increased with PCN duration. If kidney insufficiency is present after PCN removal, it is related to the complexity of kidney anomalies.
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Affiliation(s)
- Tomaž Ključevšek
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Vesna Pirnovar
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Department of Radiology, University Medical Centre, Children's Hospital Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia
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11
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Safdar O, Safhi MA, Saggaf O, Algethami HR, Alhalabi M, Alnajrani EM, Baeshen A, Filemban M. Assessment of the Etiologies and Outcomes of Antenatal Hydronephrosis in Patients at King Abdulaziz University Hospital. Cureus 2020; 12:e7615. [PMID: 32399349 PMCID: PMC7213646 DOI: 10.7759/cureus.7615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Antenatal hydronephrosis (ANH) is the most common congenital abnormality. It is often detected during pregnancy through an antenatal ultrasound (US) examination. This condition is defined as the dilatation of the renal pelvis and/or calyces in neonates. Little is known about ANH and its associated etiology and outcomes, especially in the Middle East. This study aims to determine the outcome of patients diagnosed with ANH between 2011 and 2017. Methods The current study was a retrospective analysis of data collected from the medical records of 64 ANH patients (45 male, 19 female). We collected data regarding the demographic characteristics, fetal parameters, laboratory and radiological parameters, and medical and surgical interventions. Moreover, based on radiological reports patients were classified into one of the following two groups: good prognosis, including patients with improved or resolved ANH and poor prognosis, including patients with progressing ANH and associated complications such as parenchymal scarring, chronic kidney disease complicated by secondary hypertension. Results Overall, 48.4% of patients exhibited good prognosis, whereas 51.6% exhibited poor prognosis. Among the 64 patients, 53.1% of patients exhibited unilateral ANH, and 46.9% exhibited bilateral ANH. Also, unilateral ANH and bilateral ANH had good prognoses in 41.2% and 56.7%, respectively, while unilateral and bilateral ANH had poor prognosis in 58.8% and 43.3%, respectively. Conclusions Additional prophylactic measures should be taken to avoid complications, such as urinary tract infection (UTI), as our study found that patients who have ANH are more prone to develop UTI. Patients with several ANH comorbidities are associated with poor prognosis.
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Affiliation(s)
- Osama Safdar
- Pediatrics, King Abdulaziz University, Jeddah, SAU
| | - Mohammed A Safhi
- Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Omar Saggaf
- Internal Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Mohammed Alhalabi
- Emergency Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Eyad M Alnajrani
- Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Ahmed Baeshen
- Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Marwan Filemban
- Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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12
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Abdelmaksoud S, Albishbishy M, Elayyouti M, Zohiri M, Elsaied A. Post Circumcision Intraperitoneal Rupture of the Urinary Bladder: A Rare Complication. European J Pediatr Surg Rep 2020; 8:e14-e17. [PMID: 32154063 PMCID: PMC7060082 DOI: 10.1055/s-0039-1700986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
Circumcision is one of the most common pediatric surgical procedures performed all over the world and especially in Arab and Islamic countries. Many complications have been documented following this maneuver. We report on a rare case of intraperitoneal bladder rupture in a 7-day-old baby who was circumcised on his second day using the guillotine method. He presented to us with gangrene of the tip of the penis and a failure to void urine associated with progressive abdominal distension. Ultrasound revealed severe ascites. Aspiration and analysis confirmed the fluid to be urine. Ascending cystourethrogram was performed revealing a perforation of the posterior bladder wall near the trigone. Exploration was performed and repair done. Postoperative course was uneventful.
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Affiliation(s)
- Sherif Abdelmaksoud
- Department of Paediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt, Egypt
| | - Mohammed Albishbishy
- Department of Paediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt, Egypt
| | - Mostafa Elayyouti
- Department of Paediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt, Egypt
| | - Mohamed Zohiri
- Department of Paediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt, Egypt
| | - Adham Elsaied
- Department of Paediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt, Egypt
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13
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Chalouhi GE, Millischer AÉ, Mahallati H, Siauve N, Melbourne A, Grevent D, Vinit N, Heidet L, Aigrain Y, Ville Y, Blanc T, Salomon LJ. The use of fetal MRI for renal and urogenital tract anomalies. Prenat Diagn 2019; 40:100-109. [PMID: 31736096 DOI: 10.1002/pd.5610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
Abstract
Fetal anomalies are detected in approximately 2% of all fetuses and, among these, genitourinary tract abnormalities account for 30% to 50% of all structural anomalies present at birth. Although ultrasound remains the first line diagnostic modality, fetal MRI provides important additional structural and functional information, especially with the development of faster sequences and the use of functional sequences. The added value of MRI-based imaging is three-fold: (a) improvement of diagnostic accuracy by adequate morphological examination, (b) detection of additional anomalies, and (c) in addition, MRI has the potential to provide information regarding renal function. In this review, we describe the role of fetal MRI in the anatomical evaluation of renal and urogenital tract anomalies, and we also touch upon the contribution of functional MRI to the diagnostic workup of these conditions.
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Affiliation(s)
- Gihad E Chalouhi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Division of Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.,Université de Paris, Paris, France
| | - Anne-Élodie Millischer
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Houman Mahallati
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Nathalie Siauve
- Imagerie Médicale, Hôpital Louis Mourier APHP, Colombes, France
| | - Andrew Melbourne
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Grevent
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Nicolas Vinit
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Laurence Heidet
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Pediatric Nephrology Department, Hôpital Universitaire Necker-Enfants Malades, Sorbonne Paris Cité University, Paris, France
| | - Yves Aigrain
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Yves Ville
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Institut Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Université de Paris, Paris, France
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14
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Hodhod A, Capolicchio JP, Jednak R, Wei S, Abdallah MM, El-Doray AEA, El-Sherbiny M. Does the presence of non-refluxing hydroureter impact the management and outcome of high-grade hydronephrosis? Can Urol Assoc J 2019; 14:E94-E100. [PMID: 31599717 DOI: 10.5489/cuaj.6080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the impact of non-refluxing hydroureter on the initial management of high-grade hydronephrosis (HGH) management. Moreover, we evaluated the occurrence of febrile urinary tract infection (fUTI) and surgical intervention for conservatively managed units. METHODS Patients' charts with postnatal hydronephrosis from 2008-2014 were retrospectively reviewed. We included patients who presented in the first year of life. All included patients had HGH (Society of Fetal Ultrasound [SFU] grades 3 and 4) and all were non-refluxing using voiding cystourethrogram (VCUG). We categorized renal units into two groups: with hydroureteronephrosis (HUN) and without hydroureter (isolated hydronephrosis [IH]). We recorded the initial management. We evaluated the impact of non-refluxing hydroureter on hydronephrosis fate, fUTI, and change to surgery for those managed conservatively. RESULTS We included 169 patients (180 units). IH was diagnosed in 146 units (137 patients), whereas 34 units (32 patients) had HUN. Median followup was 42.9 months. A total of 25.3% (37/146) of IH units had initial surgical management in comparison to 5.1% (2/34) of HUN units (p=0.01). During conservative management, nine HUN patients (30%) and 11 IH patients (10.7%) experienced fUTI (p=0.009). Surgical intervention after failed conservative management was indicated for 12 IH units (11%) and six HUN units (18.8%) (p=0.25). Anteroposterior diameter (APD) worsening was significantly associated with the change to surgery in IH group (p=0.003). More than half (52.3%) of IH units resolved during conservative management in comparison to 18.7% of HUN (p<0.001). HUN had longer time to resolution (log rank=0.004). CONCLUSIONS IH units had more initial surgical interventions. The fUTI rate was much higher in association with dilated ureter even under antibiotic coverage. HUN was associated with less and slower resolution rate.
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Affiliation(s)
- Amr Hodhod
- Department Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.,Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - John-Paul Capolicchio
- Department Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Roman Jednak
- Department Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Sunny Wei
- Department Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | | | - Abd El-Alim El-Doray
- Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Mohamed El-Sherbiny
- Department Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
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15
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Postnatal outcomes of babies diagnosed with hydronephrosis in utero in a tertiary care centre in India over half a decade. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2018-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Prenatal hydronephrosis is defined as the dilatation of the fetal renal pelvis and/or calyces and is the commonest anomaly detected in utero
Methods
This was a retrospective study to look at how well 148 antenatally detected cases of fetal hydronephrosis correlated with postnatal evaluation.
Results
Antenatal hydronephrosis was detected with a prevalence of 0.33%. The mean gestational age at diagnosis was 25.48 [standard deviation (SD) 6.36]. One hundred and sixteen (78.3%) fetuses had serial ultrasound scans during pregnancy to look for the progression of the condition. At the time of diagnosis, 30.1% of the fetuses were diagnosed to have mild hydronephrosis, 43.9% to have moderate hydronephrosis and 25.8% to have severe hydronephrosis. Follow-up ultrasounds during the prenatal period, 65% showed progression of the renal pelvis dilatation, 25.8% showed stable disease and 9.1% showed resolution on their subsequent scan. Almost half (46%) were found to have transient/physiological hydronephrosis. Thirty-one (20.9%) of the babies required an operation. An anteroposterior renal pelvis diameter (APD) of the fetal renal pelvis ≥17.5 mm can predict the need for surgery with a sensitivity of 70% and a specificity of 76.6%.
Conclusion
Counselling and decisions must be based on a series of ultrasound scans rather than a single evaluation. We use a cut-off of 17.5 mm as an indicator of possible postnatal surgical intervention.
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16
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Dekirmendjian A, Braga LH. Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention. Front Pediatr 2019; 7:126. [PMID: 31111023 PMCID: PMC6499225 DOI: 10.3389/fped.2019.00126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The risk of febrile urinary tract infection (fUTI) in children with primary non-refluxing megaureter (PM) has been extensively studied in the literature, however, a paucity of information exists regarding risk factors for surgical intervention and spontaneous resolution. We sought to analyze data from our prospectively collected PM cohort to determine risk factors that would predict surgery and resolution in this population. Methods: Patients with PM were identified from our prospectively-collected prenatal hydronephrosis (HN) database from 2008 to 2017. Primary outcomes included surgical intervention and hydroureter resolution. Spontaneous resolution was defined as ureteral dilation <7 mm at last follow-up. Age at presentation, gender, development of fUTI, HN grade [low (SFU I/II) vs. high (SFU III/IV)], anteroposterior diameter (APD) measurements and ureteral diameter at baseline and last follow-up were recorded. Univariate and multivariable analyses (binary logistic and Cox regression) were performed. Results: Of 101 patients, 86 (85%) were male, and 80 (79%) had high grade HN. Median age at baseline and last follow-up were 2 (0-23) and 29 (2-107) months, respectively. Overall, 23 (23%) patients underwent surgery at a median age of 22 (3-35) months. Mean ureteral diameter was larger in surgical patients vs. those treated non-surgically (14 ± 4 vs.11 ± 3 mm; p < 0.01). Of the 78 (77%) non-surgical patients, 43(55%) showed resolution of their ureteral dilation at a median age of 24(4-56) months. Survival analysis demonstrated that 12 patients resolved by year 1, 22 by year 2, 30 by year 3, 40 by year 4, and 43 by year 5. However, when considering resolution as APD <10 mm, 62(79%) children resolved their HN by last follow-up (29 months). Univariate and multivariable analyses (Table 1) revealed that high-grade HN at baseline, development of fUTI, and ureteric dilation ≥14 mm were significant risk factors for surgical intervention. Cox regression (Figure 2) found that ureteral dilation <11 mm was the only independent risk factor significantly associated with PM resolution (Table 2). Conclusion: Patients with PM and high-grade HN, as well as individuals with ureteral dilation ≥14 mm and fUTI were more likely to undergo surgical intervention. Ureteral dilation <11 mm was the only independent risk factor significantly associated with spontaneous resolution of PM.
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Affiliation(s)
- Adriana Dekirmendjian
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, ON, Canada
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Luis H. Braga
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, ON, Canada
- Division of Urology, Department of Surgery, McMaster Children's Hospital, Hamilton, ON, Canada
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17
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Kohata E, Kimata T, Onuma C, Yamanouchi S, Tsuji S, Ohashi A, Kaneko K. Natural course of isolated mild congenital hydronephrosis: A 2-year prospective study at a single center in Japan. Int J Urol 2019; 26:643-647. [PMID: 30883899 DOI: 10.1111/iju.13948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine a follow-up plan for mild congenital hydronephrosis in Japanese individuals. METHODS Neonates at Kansai Medical University Hospital (Hirakata, Osaka, Japan) who were diagnosed with mild congenital hydronephrosis - defined as a Society for Fetal Urology grade 1 or 2 - at 1-month old by abdominal ultrasonography between 2014 and 2016 were enrolled. These patients were encouraged to undergo repeated abdominal ultrasonography for 2 years every 3 months to investigate the course of congenital hydronephrosis. RESULTS Among 1009 neonates, congenital hydronephrosis was detected in 118 affected renal units of 100 (9.9%) patients. According to the definition of the Society for Fetal Urology, 118 affected renal units were graded as grade 1 in 87 (74%), grade 2 in 30 (25%), grade 3 in one (1%) and grade 4 in 0 units. Among them, 117 affected renal units of mild congenital hydronephrosis comprising grades 1 and 2 were subjected to ultrasonographic evaluation to monitor the natural course. The rates of resolution at 7, 10, 13, 16, 19, 22 and 25 months after birth in Society for Fetal Urology grades 1 and 2 cases were 60% and 8%, 77% and 19%, 90% and 32%, 92% and 40%, 95% and 52%, 96% and 56%, and 99% and 60%, respectively. CONCLUSIONS Grade 1 congenital hydronephrosis does not need to be followed up, because it mostly shows spontaneous resolution by 2 years of follow up without any complications. However, ultrasonographic examinations at 1-year intervals for grade 2 congenital hydronephrosis are recommended to determine the subsequent follow-up plan of patients.
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Affiliation(s)
- Eriko Kohata
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takahisa Kimata
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Chikushi Onuma
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Sohsaku Yamanouchi
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shoji Tsuji
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Ohashi
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
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18
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Cakici EK, Aydog O, Eroglu FK, Yazilitas F, Ozlu SG, Uner C, Renda R, Yılmaz E, Bulbul M. Value of renal pelvic diameter and urinary tract dilation classification in the prediction of urinary tract anomaly. Pediatr Int 2019; 61:271-277. [PMID: 30636381 DOI: 10.1111/ped.13788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/03/2018] [Accepted: 12/07/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to identify the cut-offs of postnatal anteroposterior renal pelvic diameter (APRPD), according to the urinary tract dilation (UTD) classification system, to identify the predictors of final diagnosis of UTD and the need for surgery. METHODS A total of 260 infants (336 renal units) with prenatally detected UTD were prospectively evaluated on serial ultrasonography by the same radiologist. Additional voiding cystourethrography and scintigraphy was done according to the clinical algorithm. RESULTS Prenatal and postnatal APRPD in patients with transient dilation were significantly lower than in those with urinary tract anomalies (UTA). On follow up, the slope of decrease in APRPD was significantly higher in transient dilation compared with UTA. APRPD 10 mm at first-month ultrasonography, predicted UTA with a sensitivity of 83.1%, and specificity of 71.1%. On multivariate analysis the likelihood of surgical intervention and final diagnosis were predicted independently by the UTD system risk group. CONCLUSIONS Careful ultrasonography evaluation can avoid unnecessary testing in patients with transient or clinically insignificant dilation. The UTD classification system is valid for evaluation of postnatal hydronephrosis and is reliable in predicting the need for surgical intervention.
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Affiliation(s)
- Evrim Kargin Cakici
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ozlem Aydog
- Department of Pediatric Nephrology, 19 Mayis University Medical School, Samsun, Turkey
| | - Fehime Kara Eroglu
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazilitas
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sare Gulfem Ozlu
- Department of Pediatric Nephrology, Yıldırım Beyazıt University Medical School, Ankara, Turkey
| | - Cigdem Uner
- Department of Radiology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rahime Renda
- Department of Pediatric Nephrology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Engin Yılmaz
- Department of Pediatric Surgery, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bulbul
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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19
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Zhang L, Li Y, Liu C, Li X, Sun H. Diagnostic Value of Anteroposterior Diameter of Renal Pelvis for Predicting Postnatal Surgery: A Systematic Review and Meta-Analysis. J Urol 2018; 200:1346-1353. [PMID: 30563653 DOI: 10.1016/j.juro.2018.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE We assessed the diagnostic value of anteroposterior diameter of the fetal renal pelvis in predicting postnatal surgery. MATERIALS AND METHODS PubMed®, Embase® and Cochrane Library databases were searched for articles comparing patients who underwent surgery or conservative therapy with 15 mm anteroposterior diameter as a cutoff value. Data on sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR and area under the summary ROC curve were used to evaluate the diagnostic value of anteroposterior diameter of the fetal renal pelvis in predicting postnatal surgery. RESULTS Five studies involving a total of 1,159 patients met the inclusion criteria. The summary sensitivity and specificity were 0.81 (95% CI 0.60 to 0.92) and 0.78 (95% CI 0.68 to 0.86), respectively. Positive and negative likelihood ratios of anteroposterior diameter were 3.73 (95% CI 2.75 to 5.06) and 0.24 (95% CI 0.11 to 0.52), respectively. Diagnostic OR of anteroposterior diameter for predicting postnatal surgery was 13.33 (95% CI 6.61 to 26.89) and area under the summary ROC curve was 0.85 (95% CI 0.82 to 0.88). Subgroup analysis suggested postnatal anteroposterior diameter was associated with higher diagnostic OR compared to prenatal anteroposterior diameter for predicting postnatal surgery (ratio between prenatal and postnatal anteroposterior diameter 0.27, 95% CI 0.09 to 0.86, p = 0.026). CONCLUSIONS Using 15 mm anteroposterior diameter of the fetal renal pelvis as a cutoff showed moderate diagnostic value for predicting postnatal surgery.
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Affiliation(s)
- Lei Zhang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan (LZ), Shandong, China; Department of Pediatric Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong, China.
| | - Yan Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan (LZ), Shandong, China; Department of Pediatric Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong, China
| | - Chao Liu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan (LZ), Shandong, China; Department of Pediatric Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong, China
| | - Xiang Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan (LZ), Shandong, China; Department of Pediatric Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong, China
| | - Hao Sun
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan (LZ), Shandong, China; Department of Pediatric Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong, China
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20
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Ellison JS, Dy GW, Fu BC, Holt SK, Gore JL, Merguerian PA. Neonatal Circumcision and Urinary Tract Infections in Infants With Hydronephrosis. Pediatrics 2018; 142:peds.2017-3703. [PMID: 29880703 DOI: 10.1542/peds.2017-3703] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Boys with urinary tract abnormalities may derive a greater benefit from newborn circumcision for prevention of urinary tract infection (UTI) than the general population. However, the effect of newborn circumcision on UTI is not well characterized across the etiological spectrum of hydronephrosis. We hypothesized that boys with an early diagnosis of hydronephrosis who undergo newborn circumcision will have reduced rates of UTI. METHODS The MarketScan data set, an employer-based claims database, was used to identify boys with hydronephrosis or hydronephrosis-related diagnoses within the first 30 days of life. The primary outcome was the rate of UTIs within the first year of life, comparing circumcised boys with uncircumcised boys and adjusting for region, insurance type, year of birth, and infant comorbidity. RESULTS A total of 5561 boys met inclusion criteria, including 2386 (42.9%) undergoing newborn circumcision and 3175 (57.1%) uncircumcised boys. On multivariate analysis, circumcision was associated with a decreased risk of UTI in both boys with hydronephrosis and healthy cohorts: odds ratio (OR) 0.36 (95% confidence interval [CI] 0.29-0.44) and OR 0.32 (95% CI 0.21-0.48), respectively. To prevent 1 UTI, 10 patients with hydronephrosis would have to undergo circumcision compared with 83 healthy boys. Among specific hydronephrosis diagnoses, circumcision was associated with a reduced risk of UTI for those with isolated hydronephrosis (OR 0.35 [95% CI 0.26-0.46]), vesicoureteral reflux (OR 0.35 [95% CI 0.23-0.54]), and ureteropelvic junction obstruction (OR 0.35 [95% CI 0.20-0.61]). CONCLUSIONS Newborn circumcision is associated with a significantly lower rate of UTI among infant boys with hydronephrosis.
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Affiliation(s)
- Jonathan S Ellison
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington; and
| | - Geolani W Dy
- Department of Urology, University of Washington, Seattle, Washington
| | - Benjamin C Fu
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington; and
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, Washington
| | - John L Gore
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington; and
| | - Paul A Merguerian
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington; and
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de Roo R, Voskamp BJ, Kleinrouweler CE, Mol BW, Pajkrt E, Bouts AHM. Determination of threshold value for follow-up of isolated antenatal hydronephrosis detected in the second trimester. J Pediatr Urol 2017; 13:594-601. [PMID: 29133166 DOI: 10.1016/j.jpurol.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/14/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Isolated antenatal hydronephrosis (ANH), defined as a dilation of the renal pelvis (≥5 mm), is one of the most common abnormalities detected on prenatal ultrasound. However, established cut-off values for postnatal follow-up differ between countries and are based on little evidence. The current protocol in the Netherlands for follow-up might be too conservative. OBJECTIVE To assess the applicability of a higher threshold for follow-up of isolated antenatal hydronephrosis (ANH) than the current practice, without the risk of missing significant postnatal urinary tract obstruction. STUDY DESIGN Retrospective case series on all fetuses with isolated ANH (anteroposterior pelvic diameter (APPD) ≥5 mm) at the second trimester anomaly scan, and diagnosed between 2000 and 2009, in relationship to renal outcome. RESULTS A total of 279 infants with second trimester isolated ANH were included. In 201/279 (72%) fetuses, ANH had normalized (APPD <10 mm) before the third trimester scans. Hydronephrosis persisted postnatally in a minority of 56/279 (20.1%). Postnatal assessment showed signs of obstruction in 41/279 (14.7%) infants, duplicated collecting system or vesicoureteral reflux (VUR). Surgery was performed in 18/279 (6.5%) infants. A non-functioning kidney was shown in 6/279 (2.2%) infants with ANH. Mild ANH (APPD <7 mm) during the second trimester (172/279 (61.6%)) never resulted in surgery for renal anomalies or non-functioning kidney. Infants with an APPD ≥10 mm in the second trimester were far more likely to develop renal anomalies or undergo surgery compared with infants with an APPD 7-10 mm. The number of non-functioning kidneys was too low to be conclusive. CONCLUSIONS Follow-up ultrasounds for isolated ANH ≥7 mm instead of ≥5 mm at the second trimester scan would have saved 62% of third trimester scans, without missing any infant with a non-functioning kidney, significant obstruction or symptomatic VUR. In view of the results, it is reasonable that referral for follow-up of second trimester ANH is not strictly indicated in cases with an APPD <7 mm.
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Affiliation(s)
- Ravi de Roo
- Department of Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Bart J Voskamp
- Department of Obstetrics, Academic Medical Center AMC, Amsterdam, The Netherlands
| | | | - Ben W Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia
| | - Eva Pajkrt
- Department of Obstetrics, Academic Medical Center AMC, Amsterdam, The Netherlands
| | - Antonia H M Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
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Rickard M, Lorenzo AJ, Braga LH. Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) as a Predictor of Future Surgical Intervention for Infants With High-grade Prenatal Hydronephrosis. Urology 2016; 101:85-89. [PMID: 27713070 DOI: 10.1016/j.urology.2016.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the potential value of an objective assessment, renal parenchyma to hydronephrosis area ratio (PHAR), as an early predictor of surgery. METHODS Initial sagittal renal ultrasound (US) images of patients prospectively entered into a prenatal hydronephrosis database from January 2008 to January 2016 with baseline Society for Fetal Urology (SFU) grades III and IV prenatal hydronephrosis, without vesicoureteral reflux, were evaluated using the National Institutes of Health-sponsored image processing software. PHAR, anteroposterior diameter, SFU grade, and urinary tract dilation risk categories were contrasted with nuclear scan data (differential renal function and drainage time [t1/2]) and analyzed for predictive value in determining the decision to proceed with surgery by drawing receiver operating characteristic curves. RESULTS Out of 196 infants (162 male; 138 left sided hydronephrosis), 58 (30%) underwent surgery to address obstruction. Surgical patients compared with those managed conservatively had longer t1/2 (60 vs 18 min; P < .01) and lower differential renal function (46 vs 50%; P = .01). Of the initial US parameters, PHAR (area under the curve = 0.816; P < .001) had a better predictive performance than anteroposterior diameter, SFU grade, or urinary tract dilation classification. PHAR values correlated with subsequent parameters obtained on nuclear scan. CONCLUSION PHAR is a promising parameter that can be estimated on presentation US to help predict future need for surgery in newborns with high-grade hydronephrosis.
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Affiliation(s)
- Mandy Rickard
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada
| | - Armando J Lorenzo
- Division of Pediatric Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Ontario, Canada.
| | - Luis H Braga
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada; Division of Urology, Department of Surgery, McMaster University, Ontario, Canada
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Weitz M, Portz S, Laube GF, Meerpohl JJ, Bassler D. Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age. Cochrane Database Syst Rev 2016; 7:CD010716. [PMID: 27416073 PMCID: PMC6457949 DOI: 10.1002/14651858.cd010716.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Unilateral ureteric-pelvic junction obstruction (UPJO) is the most common cause of obstructive uropathy and may lead to renal impairment and loss of renal function. The current diagnostic approach with renal imaging cannot reliably determine which newborns and infants less than two years of age have a significant obstruction and are at risk for permanent kidney damage. There is therefore no consensus on optimal therapeutic management of unilateral UPJO. OBJECTIVES To assess the effects of surgical versus non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2016), MEDLINE/Ovid, and EMBASE/Ovid databases from their inception to 13 June 2016. We searched the reference lists of potentially relevant studies without using any language restriction. We also searched the following trial registers for relevant registered studies: www.clinicaltrials.gov/; ISRCTN registry (controlled-trials.com/); www.trialscentral.org/; apps.who.int/trialsearch/; www.drks.de/; and www.anzctr.org.au/trialSearch.aspx. SELECTION CRITERIA We selected randomised and quasi-randomised controlled trials comparing surgical with non-surgical interventions for the treatment of unilateral UPJO. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and risk of bias of included studies and extracted data. In case of disagreements we consulted a third review author. The data reported in the two included studies did not allow us to perform a meta-analysis. MAIN RESULTS We found only two studies at high risk of bias that were eligible for inclusion in this review. The total sample size, including both trials, was small (n = 107 participants less than six months of age from the UK and USA), and not all prespecified outcome measures were assessed. Reported measures only accounted for the short-term follow-ups. The mean split renal function was not statistically different between the surgical and non-surgical group at the six-month or one-year time point (very low-quality evidence). The surgical group showed a significantly less obstructed drainage pattern and a lower urinary tract dilatation than the non-surgical group (very low-quality evidence). Transfer from the non-surgical group to the surgical group was reported for about one out of five participants. Split renal function after secondary surgical intervention was reported with variable results, but most of the participants reverted to pre-deteriorated values. The studies either provided no or insufficient data on the following outcome measures: postoperative complications, UPJO-associated clinical symptoms, costs of interventions, radiation exposure, quality of life, and adverse effects. AUTHORS' CONCLUSIONS We found limited evidence assessing the benefits and harms of surgical compared to non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO. The majority of participants in the non-surgical treatment group did not experience any significant deterioration of split renal function, and only about 20% of them underwent secondary surgical intervention, with minor risk of permanent deteriorated split renal function. The study follow-up period was too short to assess the long-term effects on split renal function in both treatment groups. We need further randomised controlled trials with sufficient statistical power and an adequate follow-up period to determine the optimal therapy for newborns and infants less than two years of age with unilateral UPJO.
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Affiliation(s)
- Marcus Weitz
- Children's Hospital TuebingenPediatric NephrologyHoppe‐Seyler‐Strasse 1TuebingenGermany72076
| | - Suniva Portz
- University Hospital TuebingenDepartment of ObstetricsCalwerstraße 7TuebingenGermany72076
| | - Guido F Laube
- University Children's HospitalPediatric NephrologySteinwiesstrasse 75ZurichSwitzerland8032
| | - Joerg J Meerpohl
- Medical Center ‐ University of FreiburgCochrane GermanyBerliner Allee 29FreiburgGermany79110
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityCochrane France1 place du Parvis Notre‐DameParisFrance75181 Cedex 4
| | - Dirk Bassler
- University Hospital Zurich and University of ZurichDepartment of NeonatologyFrauenklinikstrasse 10ZurichSwitzerland
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The Fate of Primary Nonrefluxing Megaureter: A Prospective Outcome Analysis of the Rate of Urinary Tract Infections, Surgical Indications and Time to Resolution. J Urol 2016; 195:1300-5. [DOI: 10.1016/j.juro.2015.11.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2015] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE Circumcision is one of the most commonly performed operations during childhood. The procedure is often underestimated in areas where it is frequently executed due to social and religion-based indications. In fact it might be an opportunity to detect and to correct any existing penile anomaly. The aim of the study was to retrospectively evaluate the boys who were admitted to a hospital for circumcision and the outcome of the procedure. METHODS The boys who were brought to outpatient clinics for circumcision between 2009-2015, were retrospectively evaluated. The indications for hospital admission and the presence of associated penile anomalies were searched. All the boys were examined and operated by a single surgeon of the institution. RESULTS Nine hundred forty four boys were brought to pediatric surgery outpatient clinics in order to be circumcised. The operation was performed in 318 of them. The physical examination revealed penile anomalies in 29 of the 318 cases. The detected anomalies were webbed penis, penile torsion, hypospadias, chordee without hypospadias and meatal stenosis. CONCLUSIONS The proper examination of the boys by a physician prior to circumcision provides the detection of penile anomalies which can be corrected at the same session. The arrangements for performing circumcision in hospitals by the medical staff should be favored. The misleading perception of underestimation of the procedure where it is ritually performed, should be corrected.
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Affiliation(s)
- Ebru Yesildag
- Ebru Yesildag, MD. Associate Professor, Department of Pediatric Surgery, Namik Kemal University, Faculty of Medicine, Turkey
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Dos Santos J, Parekh RS, Piscione TD, Hassouna T, Figueroa V, Gonima P, Vargas I, Farhat W, Rosenblum ND. A New Grading System for the Management of Antenatal Hydronephrosis. Clin J Am Soc Nephrol 2015; 10:1783-90. [PMID: 26231195 DOI: 10.2215/cjn.12861214] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+). RESULTS The combination of APD≥6-9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD≥6-9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD≥9-15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD≥9-15 mm alone. The LR+ for surgery for diffuse caliectasis and APD≥6-9 mm was higher than for APD≥6-9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD≥9-15 mm and diffuse caliectasis than APD≥9-15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD≥6-9 mm or ≥9-15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05). CONCLUSIONS These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.
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Affiliation(s)
- Joana Dos Santos
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children
| | - Rulan S Parekh
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Division of Nephrology, Department of Medicine, University Health Network, and
| | - Tino D Piscione
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children
| | - Tarek Hassouna
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Victor Figueroa
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paula Gonima
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Isis Vargas
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Walid Farhat
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Norman D Rosenblum
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children,
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Abbo O, Patard PM, Mouttalib S, Bouali O, Vial J, Garnier A, Galinier P. [Laparoscopic transposition of lower polar vessels for pyelo-ureteral junction obstruction: preliminary experience]. Prog Urol 2015; 25:96-100. [PMID: 25554527 DOI: 10.1016/j.purol.2014.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/13/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
AIM OF THE STUDY Lower pole vessels are a classical cause of PUJO even in children. The "gold standard" in the management of PUJ obstructions remains a dismembered pyeloplasty as described by Anderson and Hynes. However, some authors have developed an alternative procedure to this approach with encouraging results. The aim of our study was to evaluate our preliminary results concerning laparoscopic vascular hitch for crossing vessels. MATERIAL AND METHODS We conducted a retrospective, monocentric study of all patients managed by this technique from January 2010 to December 2012. RESULTS Eleven patients (7 boys, 4 girls) were managed by laparoscopy at a mean age of 10.7 years (5.4-17). They were referred to our center for clinical symptoms (intermittent pain 7, high blood pressure 1, UTI 1), antenatal diagnosis or accidental discovery. Obstruction was confirmed by MAG3 nephrogram and the presence of obstructive vessels by tomodensitometry or MRI. Mean operative time was 90.2minutes (48-184). Seven patients over 11 were strictly managed by laparoscopic transposition of lower pole vessels. Four required a classical video-assisted dismembered pyeloplasty due to a potential intraluminal stenosis. The latter were suspected by a distension test with furosemid in all four cases. Mean follow-up was 12.9±3 months. Nine patients over 11 were totally non symptomatic, whereas 2 still present mild intermittent pain. In all cases, ultrasound scans show an improvement of the pelvic dilatation. CONCLUSION Laparoscopic transposition of lower pole vessels is a suitable and feasible alternative for the management of obstructive PUJ. Our preliminary experience emphasizes the need for a precise preoperative selection of patients along with a per operative evaluation of the obstruction. Further experience seems required to improve our criteria in this indication. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- O Abbo
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
| | - P-M Patard
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - S Mouttalib
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - O Bouali
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - J Vial
- Service de radiologie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - A Garnier
- Service de néphrologie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - P Galinier
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
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Rianthavorn P, Limwattana S. Diagnostic accuracy of neonatal kidney ultrasound in children having antenatal hydronephrosis without ureter and bladder abnormalities. World J Urol 2015; 33:1645-50. [DOI: 10.1007/s00345-015-1478-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/31/2014] [Indexed: 12/11/2022] Open
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de Grauw AM, den Dekker HT, de Mol AC, Rombout-de Weerd S. The diagnostic value of routine antenatal ultrasound in screening for congenital uropathies. J Matern Fetal Neonatal Med 2014; 29:237-41. [DOI: 10.3109/14767058.2014.996125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anne M. de Grauw
- Department of Pediatrics, Albert Schweitzer Hospital Dordrecht, The Netherlands,
- Department of Pediatrics, Leiden University Medical Centre Leiden, The Netherlands,
| | - Herman T. den Dekker
- Department of Pediatrics, Albert Schweitzer Hospital Dordrecht, The Netherlands,
- Department of Pediatrics, Division of Respiratory Medicine, Erasmus MC – Sophia Children’s Hospital Rotterdam, The Netherlands,
- Department of Epidemiology, Erasmus MC Sophia – Children’s Hospital Rotterdam, The Netherlands, and
| | - Amerik C. de Mol
- Department of Pediatrics, Albert Schweitzer Hospital Dordrecht, The Netherlands,
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Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, Cooper C, Crino J, Darge K, Herndon CDA, Odibo AO, Somers MJG, Stein DR. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10:982-98. [PMID: 25435247 DOI: 10.1016/j.jpurol.2014.10.002] [Citation(s) in RCA: 297] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/08/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Urinary tract (UT) dilation is sonographically identified in 1-2% of fetuses and reflects a spectrum of possible uropathies. There is significant variability in the clinical management of individuals with prenatal UT dilation that stems from a paucity of evidence-based information correlating the severity of prenatal UT dilation to postnatal urological pathologies. The lack of correlation between prenatal and postnatal US findings and final urologic diagnosis has been problematic, in large measure because of a lack of consensus and uniformity in defining and classifying UT dilation. Consequently, there is a need for a unified classification system with an accepted standard terminology for the diagnosis and management of prenatal and postnatal UT dilation. METHODS A consensus meeting was convened on March 14-15, 2014, in Linthicum, Maryland, USA to propose: 1) a unified description of UT dilation that could be applied both prenatally and postnatally; and 2) a standardized scheme for the perinatal evaluation of these patients based on sonographic criteria (i.e. the classification system). The participating societies included American College of Radiology, the American Institute of Ultrasound in Medicine, the American Society of Pediatric Nephrology, the Society for Fetal Urology, the Society for Maternal-Fetal Medicine, the Society for Pediatric Urology, the Society for Pediatric Radiology and the Society of Radiologists in Ultrasounds. RESULTS The recommendations proposed in this consensus statement are based on a detailed analysis of the current literature and expert opinion representing common clinical practice. The proposed UTD Classification System (and hence the severity of the UT dilation) is based on six categories in US findings: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. The classification system is stratified based on gestational age and whether the UT dilation is detected prenatally or postnatally. The panel also proposed a follow-up scheme based on the UTD classification. CONCLUSION The proposed grading classification system will require extensive evaluation to assess its utility in predicting clinical outcomes. Currently, the grading system is correlated with the risk of postnatal uropathies. Future research will help to further refine the classification system to one that correlates with other clinical outcomes such as the need for surgical intervention or renal function.
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Affiliation(s)
- Hiep T Nguyen
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA.
| | - Carol B Benson
- Society of Radiologists in Ultrasounds (SRU), Reston, VA, USA; American College of Radiology (ACR), Reston, VA, USA
| | - Bryann Bromley
- American Institute of Ultrasound in Medicine (AIUM), Laurel, MD, USA
| | - Jeffrey B Campbell
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Jeanne Chow
- Society for Pediatric Radiology (SPR), Reston, VA, USA
| | - Beverly Coleman
- American College of Radiology (ACR), Reston, VA, USA; Society of Radiologists in Ultrasounds (SRU), Reston, VA, USA
| | - Christopher Cooper
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Jude Crino
- Society for Maternal-Fetal Medicine (SMFM), Washington, D.C., USA
| | - Kassa Darge
- Society for Pediatric Radiology (SPR), Reston, VA, USA
| | - C D Anthony Herndon
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Anthony O Odibo
- Society for Maternal-Fetal Medicine (SMFM), Washington, D.C., USA
| | | | - Deborah R Stein
- American Society of Pediatric Nephrology (ASPN), The Woodlands, TX, USA
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Epelman M, Daneman A, Donnelly LF, Averill LW, Chauvin NA. Neonatal Imaging Evaluation of Common Prenatally Diagnosed Genitourinary Abnormalities. Semin Ultrasound CT MR 2014; 35:528-54. [DOI: 10.1053/j.sult.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sharma G, Sharma A. Postnatal management of antenatally detected hydronephrosis. World J Clin Urol 2014; 3:283-294. [DOI: 10.5410/wjcu.v3.i3.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 08/05/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
With the increasing use of ultrasonography, congenital anomalies are often picked in utero. Antenatally detected hydronephrosis is amongst the most commonly detected abnormality. The management of this condition has raised considerable debate amongst clinicians dealing with it. This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis. A detailed review of the current literature on this topic is provided. Also, guidelines have been given to facilitate the management of this condition.
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Papachristou F, Pavlaki A, Printza N. Urinary and serum biomarkers in ureteropelvic junction obstruction: a systematic review. Biomarkers 2014; 19:531-40. [DOI: 10.3109/1354750x.2014.943292] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fotios Papachristou
- 1st Pediatric Department, Aristotle University, Hippokratio Hospital
ThessalonikiGreece
| | - Antigoni Pavlaki
- 1st Pediatric Department, Aristotle University, Hippokratio Hospital
ThessalonikiGreece
| | - Nikoleta Printza
- 1st Pediatric Department, Aristotle University, Hippokratio Hospital
ThessalonikiGreece
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