Predictive Value of Decreased Renal Pelvis Anteroposterior Diameter in Prone Position for Prenatally Detected Hydronephrosis

Abstract

It is important to differentiate between those cases of prenatally detected hydronephrosis that are significant and those that are likely to resolve spontaneously. We evaluated the anteroposterior pelvic diameter of the renal pelvis postnatally in the supine and prone positions, and determined whether the difference between these 2 positions helps predict the outcome of prenatally detected hydronephrosis. From May 2009 to June 2011, 38 infants with prenatally detected unilateral ureteropelvic junction type hydronephrosis were evaluated. The anteroposterior pelvic diameter was noted in the supine and prone positions. Functional evaluation was done by radionuclide renogram. Those with a split function of less than 40% underwent pyeloplasty. All other patients were followed by serial ultrasound examination. Six infants had an anteroposterior pelvic diameter larger than 40 mm with no change in diameter in the supine vs prone positions. Seven of 16 infants with an anteroposterior pelvic diameter between 30 and 40 mm, and 11 of 15 infants with an anteroposterior pelvic diameter between 15 and 30 mm had a smaller anteroposterior pelvic diameter in the prone position. These infants had normal renal function, improvement in hydronephrosis and did not need pyeloplasty. All the infants with no change in anteroposterior pelvic diameter in either position had poorer renal function, necessitating pyeloplasty. Those cases of prenatally detected ureteropelvic junction type of hydronephrosis in which the anteroposterior pelvic diameter is smaller in the prone position than in the supine position showed improvement in hydronephrosis, while those with no change in anteroposterior pelvic diameter had worsening of hydronephrosis and needed surgical intervention.