Abstract
BackgroundHydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes.MethodsThis was a retrospective review of patients referred to a tertiary care fetal-maternal clinic with diagnosis of prenatal HN from 2004 to 2019. HN severity was categorized as mild, moderate, or severe. Data were analyzed to determine the association between HN severity and surgical intervention. Decision for surgery was based on factors including history of multiple urinary tract infections, evidence of renal scarring, and/or reduced renal function. Surgery-free survival time was represented by the Kaplan–Meier method, and hazard ratios were calculated using the log-rank test.Results131 kidneys among 101 infants were prenatally diagnosed with hydronephrosis; 35.9% had mild HN, 29.0% had moderate HN, and 35.1% had severe HN. 8.5% of patients with mild HN, 26.3% of patients with moderate HN, and 65.2% of patients with severe HN required surgery. Patients with severe HN were 12.2 (95% CI 6.1–24.4; p < 0.001) times more likely to undergo surgery for HN than patients with mild HN and 2.9 (95% CI 1.5–5.3; p = 0.003) times more likely to undergo surgery than patients with moderate HN. Patients with moderate HN were 4.3 times more likely to require surgery than patients with mild HN (95% CI 1.5–12.9; p = 0.01). Median age at surgery was 11.8 months among patients with mild HN (IQR 11.7–14.1 months), 6.6 months among patients with moderate HN (IQR 4.2–16.4 months), and 5.4 months among patients with severe HN (3.7–12.4 months).ConclusionAmong this cohort of referrals from a fetal-maternal clinic, severity of HN correlated with increased likelihood of surgical intervention. Continued assessment of patients with prenatal HN should be evaluated to best determine the role of the pediatric urologist in cases of prenatal HN.
Highlights
Hydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound
33.6% (n = 44) of hydronephrotic kidneys required surgical intervention, including 8.5% of kidneys diagnosed with mild HN, 26.3% of those diagnosed with moderate HN, and 65.2% of those diagnosed with severe HN (Table 2)
Data from this study suggest that patients with severe prenatal HN require close postnatal follow-up and may require surgery within the first six months of life
Summary
Hydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes. Hydronephrosis (HN) is a descriptive term for dilation of one or both kidneys It is the most common prenatal abnormality detected by ultrasound [1] and is diagnosed in one to five percent of pregnancies [2, 3]. There is debate about the cutoff values for the SFU grading system, though efforts have been made by various professional groups to consolidate findings into a more comprehensible management guide for practicing urologists [4]. Another highly contested matter is the threshold at which surgical intervention is needed. Age, and the presence of urological comorbidities are factors that must be considered during the course of treatment
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