MP70-02 THE UTILITY OF RENAL MEDULLARY PYRAMIDAL THICKNESS MEASUREMENTS ON THE FIRST AND SECOND POSTNATAL ULTRASOUND IN INFANTS WITH CONGENITAL HYDRONEPHROSIS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP70-02 THE UTILITY OF RENAL MEDULLARY PYRAMIDAL THICKNESS MEASUREMENTS ON THE FIRST AND SECOND POSTNATAL ULTRASOUND IN INFANTS WITH CONGENITAL HYDRONEPHROSIS Kathleen Kwiatkowski, Tomas Lence, Angelena Edwards, Gina Lockwood, Douglas Storm, Hanh Pham, and Christopher Cooper Kathleen KwiatkowskiKathleen Kwiatkowski More articles by this author , Tomas LenceTomas Lence More articles by this author , Angelena EdwardsAngelena Edwards More articles by this author , Gina LockwoodGina Lockwood More articles by this author , Douglas StormDouglas Storm More articles by this author , Hanh PhamHanh Pham More articles by this author , and Christopher CooperChristopher Cooper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies demonstrating a medullary pyramid thickness (PT) < 3mm as a marker of obstruction and risk of pyeloplasty used the postnatal ultrasound (u/s) demonstrating the largest degree of hydronephrosis (hydro). Since early identification of children at risk of obstruction is clinically useful, we reviewed the PT on the 1st and 2nd postnatal u/s in infants with congenital hydro. Objectives were to determine the prognostic value of: 1) the PT on the 1st and 2nd u/s, 2) a change in PT between the 1st and 2nd u/s, and 3) the ratio of the PT in the hydronephrotic kidney to the contralateral PT in the normal kidney in those with unilateral hydro. We hypothesized that a smaller PT on either the 1st or 2nd ultrasound, as well as a decreasing PT between the 1st and 2nd u/s, and a decreased PT ratio with unilateral hydro, would each be early predictors of pyeloplasty. This study also analyzed the impact on predictive ability of the PT obtained on an u/s obtained<3 days of life compared to those in which the 1st u/s was obtained>3 days of life. METHODS: A chart and u/s review of children with isolated SFU grade 3 or 4 hydro was performed. 91 infants (77 boys and 14 girls) met eligibility criteria (105 kidneys). The median age (IQR) at 1st u/s was 1.5 (1.0-15.0) days and 54.0 (27.5-123.0) days at the 2nd u/s. RESULTS: For the group overall, a smaller PT on both the 1st and 2nd u/s was associated with an increased risk of pyeloplasty (p=0.02 and<0.001, respectively), however, a PT obtained on an u/s<3 days of life was not predictive. A PT of <3 mm on an u/s obtained>3 days of life was associated with higher risk of pyeloplasty (AUC=0.8). In addition, a decreasing PT between the 1st and 2nd u/s was a risk factor for pyeloplasty (p=0.002). The PT ratio of hydronephrotic to normal contralateral kidney of the children who had their 1st u/s>3 days of life was also significant in predicting pyeloplasty (p=0.018). A ratio < 6 mm, 6-9 mm, and > 9 mm conveyed a very high risk, intermediate risk, and low risk of pyeloplasty, respectively (AUC=0.83). CONCLUSIONS: PT measured on the 1st and 2nd postnatal u/s is useful in determining the risk of pyeloplasty. The PT obtained on the 1st u/s was less predictive when obtained <3 days of life compared to >3 days of life. A decreasing PT between 1st and 2nd u/s was a risk factor for pyeloplasty. With unilateral hydronephrosis, a smaller PT ratio of the hydronephrotic kidney to the normal contralateral kidney was a significant predictor of pyeloplasty. Source of Funding: Tyrone D. Artz Chair in Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1003 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathleen Kwiatkowski More articles by this author Tomas Lence More articles by this author Angelena Edwards More articles by this author Gina Lockwood More articles by this author Douglas Storm More articles by this author Hanh Pham More articles by this author Christopher Cooper More articles by this author Expand All Advertisement PDF downloadLoading ...