Anteroposterior Pelvic Diameter Research Articles

Predictive Value of the Postural Difference in Antero-Posterior Diameter of Renal Pelvis on Ultrasonography of Unilateral Ureteropelvic Junction Obstruction in Determining the Need For Surgery.

Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients. We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for non-normally distributed data). We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings. We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant.

Efficiency of HoLEP in patients with detrusor underactivity and renal dysfunction secondary to BPO

PurposeThe purpose of this study was to assess the bladder and renal functional outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic obstruction (BPO) complicated by detrusor underactivity (DU) and secondary renal dysfunction.MethodsThirty-one patients were included in this prospective study. Eligible patients had urinary retention, a bladder outlet obstruction index (BOOI) greater than 40, a bladder contractility index (BCI) less than 100, abnormal renal function at the initial diagnosis (serum creatinine > 132 µmol/L) and a renal pelvis anteroposterior diameter (PRAPD) > 1.5 cm bilaterally. All patients underwent HoLEP in a routine manner and were evaluated preoperatively and at 1, 3 and 6 months after surgery. The baseline characteristics of the patients, perioperative data, postoperative outcomes and complications were assessed.ResultsSignificant improvement was observed in the international prostate symptom score (IPSS), quality of life (QoL) score, maximal urinary flow rate (Qmax), post-void residual volume (PVR), Scr and RPAPD at the 6-month follow-up. Bladder wall thickness (BWT) exhibited a decreasing trend but did not significantly differ from the preoperative values. No grade 3 or higher adverse events occurred, and grade 3 and lower complications were treated conservatively. Three patients required reinsertion of indwelling catheters, and they were able to void spontaneously after two weeks of catheterisation training and medication treatment.ConclusionHoLEP is an effective treatment for men with BPO accompanied by DU and consequent renal function impairment. Patients are able to regain spontaneous voiding. Both bladder and renal functions were preserved and improved.

New Insights into the Diagnosis, Monitoring, and Management of Antenatal Hydronephrosis, Aiming to Refine Treatment Protocols: A Clinical Study.

Antenatal hydronephrosis (ANH) is a common prenatal finding that requires careful evaluation to determine appropriate management strategies. The variability in outcomes underscores the need for refined diagnostic and monitoring protocols to differentiate between cases necessitating intervention and those likely to resolve spontaneously. A prospective clinical study was conducted involving 150 pregnant women diagnosed with ANH between gestational weeks 18 to 24. Prenatal ultrasounds were performed at regular intervals to monitor renal pelvic dilatation. Postnatal evaluations included renal ultrasound, voiding cystourethrography, and nuclear renal scans to assess renal function and identify associated anomalies. Management decisions were based on standardized criteria including degree of hydronephrosis, presence of associated anomalies, and renal function. Of the 150 cases, 80 (53.3%) resolved spontaneously during the prenatal period, while 70 (46.7%) required postnatal intervention. Among the intervention group, 45 cases (64.3%) required surgical correction for persistent hydronephrosis or associated anomalies, while the remaining 25 cases (35.7%) were managed conservatively with close monitoring. Arbitrarily, the mean anteroposterior renal pelvic diameter (APRPD) in the resolved group was 5.2 mm, compared to 10.6 mm in the intervention group. The median postnatal follow-up duration was 24 months. This study highlights the importance of systematic evaluation and monitoring in managing ANH. While a significant proportion of cases resolve spontaneously, a careful assessment of associated anomalies and renal function is crucial in identifying cases requiring intervention. The arbitrary APRPD values presented underscore the potential for establishing diagnostic thresholds to guide clinical decision-making. Refinement of treatment protocols based on such parameters can improve outcomes and reduce unnecessary interventions in infants with ANH.

Could radiological parameters help to predict the failure of ureteral access sheath placement

To identify the radiological parameters which may help to predict the success of ureteral access sheath (UAS) placement during retrograde intrarenal surgery (RIRS).The study included 49 patients in whom failure ureteral access sheath placement in RIRS and 49 control group patients who were successfully placement between January 2023 and December 2023. The age, gender, body mass index (BMI), non-contrast computed tomography (NCCT), and kidney ureter bladder (KUB) radiographs were compared between the two groups. Measurements of the anteroposterior (ap) diameter of the pelvic inlet, anteroposterior diameter of the pelvic outlet, interspinous distance diameter were taken from non-contrast computed tomography (NCCT), while pelvic anteroposterior diameter and pelvic lateral diameter were measured from kidney ureter bladder (KUB) radiography. There were no significant differences between the groups in age, gender, body mass index, ap pelvic inlet diameter, ap pelvic outlet, and interspinous distance diameter. However, a statistically significant difference was found between the pelvic ap diameter and pelvic lateral diameter values measured on the KUB radiography. The values for pelvic ap diameter and pelvic lateral diameter measured in the KUB radiographs can be used to predict the likelihood of UAS passage during RIRC procedures. However, further studies with larger patient groups are needed to establish a cut-off value.

Variations in pelvic floor thickness in relation to bony dimensions in South African women: using computed tomography scans

Pelvic floor disorders (PFDs) are a common reason for urogynaecological consultation around the world, especially in elderly women. These disorders have been associated with disruption to the structural integrity of the pelvic floor. This study explored whether there are variations in pelvic floor muscle (PFM) thickness in relation to parity, population group and age. Additionally, the study explored whether there were any correlations between PFM thickness and the bony pelvic parameters measured. This was a quantitative retrospective analysis of computerised tomography (CT) scans. A total of 125 CT scans of women belonging to black and white South African population groups were sampled from a tertiary hospital in Pretoria, South Africa. Statistical analyses were performed using Paleontological Statistics (PAST). A thicker pelvic floor was noted in black compared to white women. Pelvic floor thickness decreased with parity and age in both population groups. The intertuberous diameter, as well as the surface areas of the urogenital triangle and the perineum, were statistically significantly larger in white than in black women. Correlations between PFM thickness and bony dimensions were statistically significant for anteroposterior (AP) pelvic outlet diameter, where a greater AP outlet was associated with thinner PFMs in black women. Bony correlations with parity showed that the interspinous diameter in black women increased significantly with parity. The variations in bony pelvic dimensions and pelvic floor muscle thicknesses noted between population groups, in addition to the co-factors of parity and aging, will contribute to a better understanding of the anatomical reasons for incontinence.

Ultrasound evaluation of stiffness and vascularity of renal parenchymal damage secondary to hydronephrosis in pediatric patients using shear wave elastography and superb microvascular imaging

AbstractAimsThe purpose of this study is to assess the diagnostic value of SWE (shear wave elastography) and renal parenchymal elasticity and microvascularization with the SMI (super microvascular imaging) technique in diagnosing and predicting the progression of renal parenchymal damage in pediatric patients with hydronephrosis.Patients and MethodsA total of 45 patients were included in the prospective study. To evaluate parenchymal changes, SWE and SMI‐Vacularity Index (VI) measurements were performed in various sections of the affected and normal kidneys. The affected and control renal pelvises' anteroposterior (AP) diameters were also measured.ResultsThe average SWE values were measured as 16.62 kPa for the affected kidneys, whereas the control kidneys showed an average SWE value of 12.70 kPa, indicating a statistically significant difference (p < .01). Furthermore, in the affected kidneys, the average SMI‐VI value was measured as 5.92, whereas the control kidneys exhibited a higher average SMI‐VI value of 6.64, showing a statistically significant difference (p < .01). A reverse correlation was found between renal pelvis AP diameter and SMI‐VI values, while a positive correlation existed between renal pelvis AP diameter and SWE values.ConclusionsWe believe that SWE and SMI may be useful for diagnosing and predicting the progression of renal parenchymal damage in pediatric hydronephrotic patients.

Propensity score matched analysis of treatment outcomes in pediatric ureteropelvic junction obstruction: a comparison between horseshoe and non-horseshoe kidneys.

Pediatric hydronephrosis poses distinct challenges, particularly in cases involving horseshoe kidneys (HSK). This retrospective study compares treatment outcomes between HSK and non-horseshoe kidneys (NHSK) in pediatric ureteropelvic junction obstruction (UPJO) patients. A retrospective cohort study included 35 patients with HSK and 790 patients with NHSK undergoing pyeloplasty. Preoperative, intraoperative, and postoperative parameters were evaluated. Propensity score matching (PSM) balanced patient characteristics in the NHSK group. In comparison with NHSK, HSK exhibited a higher crossing vessel incidence (51.6% vs. 5.12%, P < 0.001) and smaller preoperative anteroposterior pelvic diameter (APD). Post 6 and 12months, NHSK maintained a larger APD, with a higher P/C ratio at 12months. PSM retained significantly higher crossing vessel incidence in HSK (51.6 vs. 3.61%, P < 0.001). Laparoscopic pyeloplasty (LP) in HSK showed lower postoperative length of stay (LOS). Postoperative ultrasound parameters favored NHSK. In HSK and NHSK with crossing vessels, HSK demonstrated higher complications even post-PSM (38.5% vs. 0%, P = 0.039). The study emphasizes the importance of recognizing crossing vessels in HSK-related hydronephrosis. Surgical success, although comparable between HSK and NHSK, requires tailored approaches. This investigation contributes valuable insights to pediatric urology, emphasizing personalized management for optimal outcomes.

Comparative analysis of laparoscopic and open ureteroureterostomy for the treatment of pediatric duplicated kidneys: a clinical efficacy and safety study.

Duplicated kidneys, though rare, are common in pediatric urinary issues. For children with complete kidney duplication and symptoms or complications, surgery is often needed. Ureteroureterostomy (UU) is a common procedure for this condition. This study aims to evaluate and compare the clinical efficacy and safety of laparoscopic ureteroureterostomy (LUU) and open ureteroureterostomy (OUU) in the treatment of pediatric duplicated kidneys. A retrospective study at Children's Hospital of Anhui Province from February 2017 to January 2023 included pediatric patients who underwent LUU or OUU for completely duplicated kidneys. Comparative measures included operative time, postoperative hospital stay, intraoperative blood loss, pre- and postoperative renal pelvis anteroposterior diameter, pre- and postoperative upper renal parenchymal thickness, pre- and postoperative upper ureteral diameter, and postoperative complications. There are 30 patients, 20 in the LUU group and 10 in the OUU group. All patients underwent surgery successfully, with no conversions to open surgery in the LUU group. Comparison between the LUU group (average age 3.7±3.4 years) and the OUU group (average age 1.6±1.3 years) showed that laparoscopic surgery had a mean duration of 178.8±60.71 min, intraoperative blood loss of 4.3±0.92 mL, drainage tube removal time of 1.8±0.6 days, and postoperative hospital stay of 4.2±2.2 days. In contrast, the OUU group had a mean surgery duration of 181.6±37.8 min, drainage tube removal time of 2.3±0.7 days, intraoperative blood loss of 6.4±4.06 mL, and postoperative hospital stay of 5.8±1.8 days. Although the LUU group had a shorter surgical duration, the difference was not statistically significant. However, intraoperative blood loss, drainage tube removal time, and postoperative hospital stay were significantly reduced in the LUU group, with statistical significance (P<0.05). After surgery, one case of urinary tract infection occurred in each group. Both groups had double-J stents placed postoperatively, which were removed cystoscopically 4-6 weeks later. Preoperative examinations showed no significant differences between the LUU and OUU groups in terms of upper renal pelvis anteroposterior diameter, upper renal ureteral diameter, and upper renal parenchymal thickness. However, in terms of postoperative recovery indicators, the LUU group outperformed the OUU group significantly, including upper renal pelvis anteroposterior diameter, upper renal ureteral diameter, and upper renal parenchymal thickness, with statistical significance (P<0.05). No hydronephrosis or worsening hydronephrosis was observed in the lower kidneys and ureters of the 30 patients postoperatively. Symptoms disappeared in patients with preoperative dribbling, and pain symptoms in the waist and abdomen relieved. No postoperative febrile urinary tract infections were observed. UU is an effective and safe method for treating pediatric completely duplicated kidneys. Compared to open surgery, laparoscopic surgery is associated with less trauma, faster postoperative recovery, and superior postoperative recovery of anatomical parameters (anteroposterior diameter, ureteral diameter, and parenchymal thickness) of the upper kidneys.

Should a Refluxing Internal Diversion Be Considered a Temporizing Procedure? Extended Follow-Up and Outcomes After Side-to-Side Ureterovesicostomy for Primary Obstructive Megaureter in Young Children.

We describe long-term outcomes, including UTIs and need for reimplantation, after ureterovesicostomy (UV) as a lasting surgical procedure for children with primary obstructive megaureter (POM). Children referred to our institution between 2016 and 2023 who underwent refluxing UV were analyzed. POM was defined as hydroureteronephrosis with distal ureteral dilatation > 7 mm and a negative workup for other etiologies of hydronephrosis. We assessed for surgical outcomes, complications, rate of UTI, and improvement in upper tract dilatation. Statistical analyses assessed for change in hydronephrosis metrics over follow-up. Among 183 patients diagnosed with POM, 47 (24%) underwent UV. Median age of presentation, surgery, and follow-up was 2, 9, and 43 months, respectively. A total of 7 patients developed 30-day complications: Clavien-Dindo grade 1 in 2 (transient urinary retention) and grade 2 in 5 (UTIs). During monitoring 14 (30%) developed UTIs and 7 (15%) required ureteral reimplant or UV takedown. After surgery there was a significant decrease in the proportion of patients with high-grade hydronephrosis, anteroposterior renal pelvis diameter, and maximum ureteral dilatation. Refluxing UV is a safe alternative to cutaneous diversion in POM. Most patients had improvement in upper tract dilatation with an acceptable short-term complication rate and need for reoperation (in comparison to routine later reimplantation). Our experience suggests that monitoring alone after UV is feasible, and that selective subsequent reconstruction is a reasonable strategy.

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children.

To compare the efficacy of robot-assisted single-port-plus-one pyeloplasty (RSPY) and laparoscopic single-port pyeloplasty (LSPY) in the treatment of children with ureteropelvic junction obstruction (UPJO). The clinical data of 47 children who underwent surgery for UPJO at the Department of the Pediatric Surgery of the Fujian Provincial Hospital from October 2020 to September 2022 were analyzed retrospectively. Of these 47 children, 27 received RSPY while 20 underwent LSPY. The baseline data, operation time, intraoperative anastomosis time, intraoperative blood loss, postoperative hospital stay, complications, total cost, preoperative and postoperative renal parenchymal thickness (PT), anteroposterior renal pelvis diameter (APD), and differential renal function (DRF) of the two groups were compared to evaluate the clinical efficacy of the two surgical methods. The results showed that both surgical techniques were successful and no patient transitioned to open surgery. There was no significant difference between the two groups in baseline data, intraoperative blood loss, complications, APD, and PT 6 months after surgery. There was also no significant difference in APD, PT, and DRF 12 months after surgery (all P > 0.05). Compared with the LSPY group, the RSPY group had shorter operation time [(153.04 ± 14.44) vs. (189.90 ± 32.59) min, t = -5.24, P < 0.05], less intraoperative anastomosis time [(68.81 ± 16.80) vs. (97.45 ± 11.99) min, t = -6.49, P < 0.05], shorter postoperative hospital stay [(5.96 ± 1.34) vs. (9.00 ± 1.33) d, t = -7.68, P < 0.05], but higher total cost [(57,390 ± 7,664) vs. (30,183 ± 4,219) yuan, t = 14.32, P < 0.05]. Compared with LSPY, RSPY achieves equivalent efficacy in the treatment of UPJO in children and has certain advantages by shortening the operation time, intraoperative anastomosis time, and postoperative hospital stay. However, its cost burden is heavy, and appropriate cases need to be selected for popularization and application.

Can urinary caspase-3 and cytochrome c levels be used as predictive biomarkers in the management of unilateral antenatal hydronephrosis?

We aimed to investigate the urinary caspase-3 and cytochrome c levels in patients with unilateral antenatal hydronephrosis and to determine whether changes in urinary biomarker levels could be useful for both predicting the need for surgical intervention due to ureteropelvic junction obstruction (UPJO) and postoperative surgical success. Sixty-five children with a history of unilateral antenatal hydronephrosis and postnatal anteroposterior diameter ≥ 10mm were included in this prospective case-control study between January 2013 and December 2021. The obstruction group consisted of 33 patients (28 boys, 84.8%) who underwent open dismembered pyeloplasty due to UPJO. The non-obstructive dilatation (NOD) group consisted of 32 patients (27 boys, 84.4%) with stable or improving hydronephrosis and no significant reduction in ipsilateral split renal function during follow-up, whereas 34 healthy children were enrolled in the study as a control group. Urinary urinary caspase-3 and cytochrome c levels using ELISA were measured. The median preoperative urinary caspase-3 level was significantly higher in the obstruction group when compared to the NOD group (4.82ng/mgCr vs. 2.61ng/mgCr, p = 0.013) as well as the control group (4.82ng/mgCr vs. 1.72ng/mgCr, p = 0.002). In the postoperative period, urinary caspase-3 levels significantly decreased compared to preoperative measurements (4.82ng/mgCr vs. 2.51ng/mgCr, p = 0.006) and became similar to the control group (2.51ng/mgCr vs. 1.72ng/mgCr, p = 0.422). On the other hand, no significant differences were observed in urinary cytochrome c levels between the groups. All patients who underwent pyeloplasty achieved postoperative resolution in hydronephrosis and improved drainage on MAG-3, so none of the patients required re-do pyeloplasty. Postoperative decrease in caspase-3 level was found to be compatible with adequate urine drainage on MAG-3 scan. The cut-off value of urinary caspase-3 to predict patients requiring pyeloplasty was found to be 3.31ng/mg creatinine with 63.6% sensitivity, 62.5% specificity (AUC = 0.679). In the multivariable analysis, urinary caspase-3 level (OR: 1.653, p = 0.019), anteroposterior pelvic diameter (OR: 1.401, p = 0.001), and split renal function on MAG-3 (OR: 1.277, p = 0.011) were found to be independent factors in determining patients who require surgery. Based on our preliminary findings, urinary caspase-3 levels could be a useful biomarker not only for predicting the need for surgical intervention but also for determining the postoperative surgical success in children with UPJO.

Correlation between Doppler sonography and diuretic renogram in the diagnosis and follow-up of infants with unilateral pelvi-ureteric junction obstruction

BackgroundConventionally, diuretic isotope renogram is used to establish and quantify severity of the obstruction in pelvi-ureteric junction obstruction. Doppler ultrasonography too assesses obstruction by evaluating the resistive index (RI) and resistive index ratio (RIR) in the intrarenal vasculature of the kidneys. This study aimed to note correlation between RI, RIR on Doppler ultrasonography and perfusion index (PI) on diuretic isotope renogram in suspect unilateral pelvi-ureteric junction obstruction in infants. A prospective study (2016–2019) in infants with suspect unilateral hydronephrosis, i.e. anteroposterior pelvic diameter (APPD) > 15 mm, divided into Group A (0–6 months) and Group B (6–12 months) based on the age at diagnosis. The RI, RIR and PI were noted at diagnosis, at 3 and 6 months, post-interventions and the correlation assessed.Results37/94 with hydronephrosis were included in the study. 30 among these underwent surgical intervention. A decrease in RI and RIR and increase in PI following surgery were documented at follow-up. Also, the improvement was statistically more significant in the first 3 months following intervention.ConclusionsAn increased RI and RIR and a decreased PI are good indicators of obstruction in unilateral hydronephrosis in infants. The decline in RI with increase in PI following relief of obstruction shows a positive correlation between the two. Doppler sonography may be effective in monitoring unilateral hydronephrosis with unobstructed or equivocal renogram curves and consequently negate the need for repeated nuclear scans.

Laparoscopic pyeloplasty for newborns with severe hydronephrosis.

We aimed to investigate the short-term efficacy and safety of laparoscopic pyeloplasty for treating newborns with severe hydronephrosis due to ureteropelvic junction obstruction (UPJO). A retrospective analysis was performed on 16 newborn patients with severe neonatal hydronephrosis who underwent laparoscopic pyeloplasty at our hospital from January 2021 to November 2022. All patients were regularly followed up. Laparoscopic pyeloplasty with double J stent placement was performed after the presence of severe hydronephrosis was confirmed. Among the 16 pediatric patients (13 males, 3 females), the left side was affected in 13 cases and the right side in 3. The average age at surgery was 9.50 (8.50-12.00) days, with an average weight of 3.30 ± 0.95 kg. Laparoscopic pyeloplasty was performed in all cases without the need for open conversion. The mean surgery duration was 292.06 ± 73.60 min, with minimal blood loss (2.50, 2.00-5.00 ml). Postoperative hospital stays averaged 13.44 ± 4.70 days. No anastomotic leakage occurred, and follow-ups at 1, 3, 6, and 12 months showed no stent displacement, except for one case where the stent was removed at 1 month, and the others at 3 months. There were no cases of worsened hydronephrosis, except for one with renal atrophy at the 6-month follow-up. Changes in renal pelvis anteroposterior diameter exhibited a time effect (F = 49.281, P < 0.001), with significant differences at 1, 3, 6, and 12 months postoperatively compared to preoperative values (P < 0.05). Notably, differences were observed between 6 and 3 months, as well as between 12 and 3 months postoperatively (P < 0.05). Similarly, renal parenchymal thickness changes showed a time effect Pediatric urology, Guangdong Women and Children Hospital, Guangzhou, China (F = 49.281, P < 0.001), with significant differences at 1, 3, 6, and 12 months postoperatively compared to preoperative values (P < 0.05). Significant differences were also noted between 6 and 1 month, as well as between 12 and 1 month postoperatively (P < 0.05). There was one case of urinary tract infection after surgery, and no case of recurrence was observed. Severe neonatal hydronephrosis must be treated promptly. Laparoscopic pyeloplasty is a safe and feasible treatment with minimal complications for newborn patients with severe hydronephrosis due to UPJO.

Efficacy of laparoscopic pyeloplasty for pediatric hydronephrosis caused by symptomatic versus asymptomatic endogenous ureteropelvic junction obstruction: a retrospective analysis.

To retrospectively compare the differences in the surgical efficacy and prognosis of laparoscopic pyeloplasty for hydronephrosis caused by symptomatic versus asymptomatic ureteropelvic junction obstruction (UPJO) in children and determine whether clinical symptoms affect the surgical outcome and prognosis. Children who underwent laparoscopic pyeloplasty in our hospital from January 2018 to December 2022 were retrospectively analyzed. The children were divided into symptomatic and asymptomatic groups according to their main symptoms. The primary outcomes were the surgical success rate, change in renal parenchymal thickness, and change in renal pelvis anteroposterior diameter. The secondary outcomes were postoperative complications, reoperation rate, operative duration, intraoperative blood loss, and drainage tube indwelling time. In total, 224 children with UPJO were enrolled; 148 (66.1%) were symptomatic and 76 (33.9%) were asymptomatic. The symptomatic group showed a significantly greater mean change in renal parenchymal thickness, significantly higher surgical success rate, and significantly lower postoperative complication rate. In the present study, asymptomatic children had a lower surgical success rate, less postoperative imaging improvement, and more postoperative complications than symptomatic children. The presence or absence of clinical symptoms may affect the surgical outcome and prognosis.

The Role of Varied Sonographic Criteria for Predicting Treatment and Prognosis of Antenatal Hydronephrosis: A Retrospective Cohort Study

Objective: This study aimed to compare the Society of Fetal Urology (SFU) guidelines, the anteroposterior pelvic diameter (APD), and the urinary tract dilation (UTD) classification criteria for predicting the prognosis of antenatal hydronephrosis (AH). Materials and Methods: This was a retrospective analysis of the relationship among the three classification criteria and their contribution to the diagnosis and prognosis of possible AH in a cohort of neonates. Results: This study was a retrospective review of 290 neonates. The mean age was 16.4 ± 9.0 days, and 33% of the study population comprised female babies. An image review demonstrated that 35% of the patients had severe vesicoureteral reflux (VUR), 22% exhibited severe obstruction, 40% had transient hydronephrosis, and 9% required surgery. The antenatal SFU grading criteria demonstrated a significant relationship with severe obstruction, and the postnatal SFU grading was related to the severity of VUR. The highest sensitivity for the presence of VUR for surgical intervention was obtained for prenatal SFU-1 (100%). The highest specificity was for prenatal SFU-4 (96%) for the presence of VUR, prenatal SFU-4 (99%), and postnatal SFU-4 (94%) for surgical intervention. Conclusion: No reliable sonographic findings were found to predict VUR or severe ureteropelvic junction obstruction. The SFU grading during the postnatal period may predict VUR with low sensitivity and specificity. However, all three classification criteria contributed to the evaluation of the need for treatment in this cohort.

Role of Diuretic Renography and Ultrasonography in Pelvic Ureteric Junction Obstruction among Infants: A Prospective Interventional Study

Introduction: Renography is a non invasive technique routinely used by clinicians to provide information about kidney structure and function. However, its role in the diagnosis of renovascular disease (especially in patients with renal insufficiency), the exclusion of obstruction, and during the follow-up of patients undergoing pyeloplasty is still controversial. Aim: To study the changes in Anteroposterior Pelvic Diameter (APD), cortical thickness, split renal function and T½ post pyeloplasty at three months and to determine the usefulness of these parameters in assessing successful pyeloplasty for Pelvic Ureteric Junction Obstruction (PUJO). Materials and Methods: This prospective non randomised interventional study was conducted in the Department of Nuclear Medicine, PGIMER, Chandigarh, India and Department of Paediatrics, JIPMER, Karaikal, Puducherry, India, from July 2020 to July 2021. A total of 31 infants with persistent postnatal Hydronephrosis (HDN) on Ultrasonography (USG) with no vesicoureteral reflux were included in the study and underwent 99mTc EC renography. The diagnosis of obstruction was determined by visual interpretation, renogram curves, Time to peak (Tmax), and Time from Tmax to T½max parameters. Patients with obstructed patterns in 99mTc EC renography underwent Anderson Hyne’s dismembered pyeloplasty. After three months of surgery, 99mTc EC renography and USG were performed on all enrolled patients. The Chi-square test was used for the comparison of the difference in proportion, and the Student’s t-test was used for the comparison of the mean difference, between two groups. Results: The mean age of enrolled infants was 5.79±3.36 months with a male preponderance (27 males and 4 females). Out of 31 infants, 23 (74%) showed an obstructive pattern of drainage on diuretic renogram and underwent Anderson-Hynes dismembered pyeloplasty. The observed difference in the preoperative renal USG anteroposterior diameter (27.85±14.3 mm) and parenchymal thickness (9.6±3.3 mm) vs postoperative anteroposterior diameter (8±3.19 mm) and parenchymal thickness (15.5±4.19 mm) was statistically significant (p-value=0.001). The follow-up renogram scan conducted at three months showed a significant reduction in clearance half-time (T½). However, there was no statistically significant variation in split renal function at three months after pyeloplasty. Conclusion: Both 99mTc EC renography and USG indicate the likelihood of successful pyeloplasty, and in settings with limited resources, USG may be a viable substitute for early follow-up after pyeloplasty.

Is Percentage Improvement in Anteroposterior Pelvic Diameter a Valuable Marker for Successful Drainage Postpyeloplasty in Isolated Pediatric Pelvi-ureteric Junction Obstruction.

Pelvic-ureteric junction obstruction (PUJO) causes urine stasis in the renal pelvis and progressive kidney damage. Postpyeloplasty improvement of renal function and urinary drainage is assessed by diuretic isotope renogram and ultrasonography. Renograms are expensive and have radiation exposure. This study explores whether ultrasound parameters such as percentage improvement in anteroposterior pelvic diameter (PI-APD) is a valuable markers for successful pediatric pyeloplasties. The aim of this study was to identify patients who would benefit from ultrasound monitoring of PI-APD alone instead of diuretic isotope renal scan for postoperative follow-up of pyeloplasty. This was a retrospective descriptive study. We analyzed 127 pediatric pyeloplasties performed and under follow-up between June 2016 and May 2021. We recorded the postoperative ultrasound and isotope renogram parameters. PI-APD (preoperative AP diameter - postoperative AP diameter)/preoperative AP diameter × 100) was compared with improvement in renogram parameters (differential renal function, Tmax, curve pattern, and retention) to look for a correlation between them. SPSS version 20.5, Chi-square and paired t-test were used for statistical analysis. About 73.2% of patients were males, with most cases detected antenatally (76.4%). The majority was left-sided PUJO (67.7%). The mean age at surgery was 30.8 months. We identified a statistically significant correlation between the ultrasound parameter PI-APD and the renogram parameter Tmax. There is no significant correlation between PI-APD and other renogram parameters. In patients whose ultrasound parameter PI-APD is >40% and renal parenchymal thickness has increased, isotope renograms can be avoided for follow-up of postpyeloplasty patients.

Role of urinary N-acetyl-beta-D-glucosaminidase in predicting the prognosis of antenatal hydronephrosis.

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. 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. 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). 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.

The Role of UTD Classification in Predicting Prognosis of Antenatal Hydronephrosis

Evaluation of Patients with Antenatal Hydronephrosis According to UTD Classification&#x0D; Aim: Antenatal hydronephrosis (HN) may indicate a temporary benign condition, as well as a manifestation of congenital anomalies of the kidney and urinary system (CAKUT). Different scoring systems have been introduced to recognize CAKUT cases and to perform the necessary intervention in a timely manner. The aim of this study is to reevaluate the follow-up results of patients admitted to our hospital with antenatal HN according to the Urinary Tract Dilation (UTD) classification, and to determine the prognostic prediction of the classification in determining the presence of CAKUT and the need for surgery.&#x0D; Materials and Methods: Patients admitted to Adana City Training and Research Hospital Pediatric Nephrology and Urology outpatient clinics with the diagnosis of antenatal HN between February 2020-March 2021 included in the study. Patients were grouped according to the UTD classification. &#x0D; Results: Of the 132 patients (93 male/39 female), 84 (64%) of the patients were evaluated as transient/physiological hydronephrosis, 48 (36%) as CAKUT. Isolated pelvic dilatation (pelvis anteroposterior diameter

What to Expect on the Long-term Follow-up of Pediatric Pyeloplasty: Critical Time Intervals and Risk Factors

BackgroundStandard protocol for post-pyeloplasty monitoring in children and natural course of hydronephrosis resolution have not been well defined. We aimed to analyze critical time intervals and risk factors in the long-term clinical outcomes of children who were operated for ureteropelvic junction obstruction. MethodsFiles of patients who underwent open dismembered pyeloplasty between January 2000 and December 2012 and had a ≥10 years follow-up were retrospectively reviewed. Changes in SFU hydronephrosis grade, pelvis anteroposterior diameter (APD), renal parenchymal thickness, split renal functions (SRF) on MAG-3 scan as well as development of hypertension and proteinuria were noted. Complete resolution was defined as SFU grade 0–1 or APD≤10 mm or ≥50 % APD decrease. ResultsOverall, 223 patients (161 boys, 72.1 %) with a median age of 9 (range 1–185) months underwent unilateral pyeloplasty, whereas 14 patients (13 boys, 92.8 %) with a median age of 4 (range 2–39) months underwent bilateral pyeloplasty. Median follow-up was 13 (range 10–22) years. Complete resolution was observed in 190 patients (85.2 %). None of the cases required re-do pyeloplasty. Regarding unilateral cases, postoperative changes in hydronephrosis reached a plateau at the 60th month. Also, there was no significant difference regarding SRF between the 12th month and the 60th month (p > 0.05). Hypertension developed after a median period of 12 years in 13 (5.4 %) of the patients, while proteinuria developed in four (1.6 %) patients. Bilateral disease (HR: 2.518, p = 0.034) was found to be a significant determinant for development of hypertension and/or proteinuria. ConclusionsOur results indicated that ultrasonographic findings stabilized after the 60th month postoperatively, and SRF remained stable between the postoperative 12th and the 60th months. The risk of developing hypertension and/or proteinuria was 2.5 times greater in bilateral cases. Level of EvidenceLevel II.