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Hodhod A, Eid H, Capolicchio JP, Petrella F, Sadri I, El-Sherbiny M, Jednak R, Lacroix C. How can we measure the renal pelvic anteroposterior diameter in postnatal isolated hydronephrosis? J Pediatr Urol 2023; 19:75-82. [PMID: 36100553 DOI: 10.1016/j.jpurol.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The anteroposterior diameter (APD) of the renal pelvis is a commonly used ultrasound parameter in the evaluation and management of hydronephrosis. It has been established that an APD value associated with pyeloplasty is around 25 mm. Some believe the APD should be measured at the innermost part of the renal pelvis while others suggest that it should be done at the renal contour. However, there is no consensus on the optimal APD measurement technique including whether it should be measured supine or prone. This study compared six different techniques of APD measurements, in both supine and prone positions, and further evaluated their association with pyeloplasty. METHODS Data was obtained by retrospectively reviewing patients' charts that had initial high-grade hydronephrosis (HGH) from 2008 to 2014. We recorded the patients' demographics, ultrasound data and management choice. In the mid-renal transverse plane, the APD was measured by 2 blinded investigators, at the intra-renal, renal contour and extra-renal regions of the renal pelvis in supine and prone positions (Figure A). We compared the six APD measurements based on the outcome of management (pyeloplasty vs. conservative management). The ROC curve obtained was then used to assess the ability of various APD measurements in predicting surgical intervention. The cutoff value chosen that predicts pyeloplasty was the lowest diameter with 100% specificity. RESULTS We included 129 patients (134 renal units). Forty-four renal units (42 patients) underwent pyeloplasty whereas 90 renal units (87 patients) were managed conservatively. Patients' demographics were grouped by both SFU grade and clinical outcome. Regardless of grade, the APD measurements were different in all 6 techniques. All APD measurement techniques showed good inter-rater reliability. Based on the ROC curve, all APD measurements were associated with pyeloplasty with an AUC from 0.89 to 0.91. The supine extra-renal APD measurement of 24 mm was the most sensitive cutoff value. The cutoff values ranged from 18 to 27 mm when including patients from all grades of hydronephrosis. The median APD measurements were significantly less for SFU grade 3 than grade 4 hydronephrosis in all positions (P < 0.001 for all measurements), yet the predictive cutoff value of 24 mm for the supine extra-renal was similar for both grades. CONCLUSION APD measurements differ based on the technique, but they are all equally associated with the clinical outcome of pyeloplasty. The inter-rater reliability of all techniques were excellent. Though the median APD measurements are smaller in SFU grade 3, it appears that the cutoff for a predictive renal pelvic APD does not differ between SFU grades 3 and 4 for the supine extra-renal technique. We conclude that the technique for measuring the APD needs to be specified in studies of hydronephrosis and in any grading systems.
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Affiliation(s)
- Amr Hodhod
- Division of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Hadeel Eid
- Division of Pediatric Radiology, Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - John-Paul Capolicchio
- Division of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - Francis Petrella
- Division of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Iman Sadri
- Division of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Mohamed El-Sherbiny
- Division of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Roman Jednak
- Division of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Caroline Lacroix
- Division of Pediatric Radiology, Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Paladugu S, Vasudeva A, Poojari VG, Machado NM, Roopa PS, Hegde N, Mundkur A, Kumar V. Associations, follow up data, and postnatal outcome of antenatally diagnosed Urinary Tract Dilatation - Five-year single tertiary center experience from South India. J Pediatr Urol 2023; 19:89.e1-89.e8. [PMID: 36404195 DOI: 10.1016/j.jpurol.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urinary tract dilatations (UTD) are frequently diagnosed during Mid-Trimester Anomaly Scan (MTAS), at which time, given their variable progression and heterogeneous classification systems, offering suitable counsel to the couple is challenging. OBJECTIVE Based on postnatal data, we aimed to guide parental counseling, and further evaluation of UTD diagnosed at MTAS. Specifically, the utility of multi-disciplinary UTD classification system was tested. METHODS A retrospective observational study of all UTDs included from five years (2015-2020) MTAS register. The multi-disciplinary UTD classification system was used for antenatal/postnatal UTD categorization. Follow-up data were obtained from case records until the current age of children (2-6 years). RESULTS Out of 527 fetal abnormalities, 103 had UTD at MTAS. Based on the third-trimester ultrasound, 49 were low-risk UTD A1, and 44 were increased-risk UTD A2-3 (including the nineteen UTD A1 at MTAS worsened to A2-3 by third-trimester). On postnatal follow-up of UTD A1 and A2-3, respectively, neonatal UTD P2/P3 was seen in 2% and 40.9%; complete spontaneous resolution was seen in 79.5% and 43.18%; none and 22.7% underwent surgical intervention; persistent P2/P3 UTD were seen on follow-up in 2% and 4.5% (excluding those who needed surgery); impaired renal function was seen in none and 36.3%, and recurrent UTI in 8.1% and 34.09%. The subgroup with progressive UTD (from A1 to A2-3 by third-trimester ultrasound) formed 43% of the final UTD A2-3 category. Among these 19 cases, surgical intervention was performed in eight (42%); impaired renal function was seen in 7 cases (36.8%), and recurrent UTI was seen in eight (42%). DISCUSSION Given the diverse classification systems for UTD, ours is the second Indian data proving the prognostic utility of multi-disciplinary UTD classification system, specifically at third trimester scan, based on postnatal outcome. In contrast to published guidelines, our data suggests follow-up for renal pelvis anteroposterior diameter (APD) of 4-7 mm at MTAS, as some may worsen. Similar progression has been noted in other Indian studies, but the classification systems are different. Contrary to the published literature, we could not suggest a renal APD cut-off as a single criterion to predict surgical intervention. Significant limitations are retrospective observational design and multiple sonographers. CONCLUSION Our data helps guide parental counseling and further evaluation for UTD diagnosed at MTAS. The multi-disciplinary Consensus UTD Classification system, was helpful in prognostication.
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Affiliation(s)
- Sanghamitra Paladugu
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Akhila Vasudeva
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India; Division of Foetal Medicine, Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Vidyashree Ganesh Poojari
- Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Nehal Meghna Machado
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - P S Roopa
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India; Division of Foetal Medicine, Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Nivedita Hegde
- Division of Foetal Medicine, Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Anjali Mundkur
- Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Vijay Kumar
- Department of Paediatric Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
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Hwang J, Kim PH, Yoon HM, Song SH, Jung AY, Lee JS, Cho YA. Application of the postnatal urinary tract dilation classification system to predict the need for surgical intervention among neonates and young infants. Ultrasonography 2023; 42:136-146. [PMID: 36464956 PMCID: PMC9816708 DOI: 10.14366/usg.22035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/23/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to validate the postnatal urinary tract dilation (UTD) classification system by correlating it with the need for surgical intervention. METHODS Young infants who underwent ultrasound (US) examinations for prenatal hydronephrosis were retrospectively identified. The kidney units (KUs; right, left, or bilateral) were graded from UTD P0 (very low risk) to P3 (high risk) based on seven US criteria from the UTD system. Surgery-free survival curves were constructed using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards regression analysis clustered by patients was performed. Interobserver agreement was analyzed using the weighted kappa coefficient. RESULTS In total, 504 KUs from 336 patients (mean age, 18.3±15.9 days; range, 1 to 94 days; males, n=276) were included, with a median follow-up of 24.2 months. Fifty-eight KUs underwent surgical intervention. Significant differences were observed among the Kaplan-Meier curves stratified into UTD groups (P<0.001). The presence of anterior-posterior renal pelvic diameter ≥15 mm (hazard ratio [HR], 8.602; 95% confidence interval [CI], 1.558 to 43.065), peripheral calyceal dilation (HR, 8.190; 95% CI, 1.558 to 43.065), ureteral dilation (HR, 2.619; 95% CI, 1.274 to 5.380), parenchymal thickness abnormality (HR, 3.371; 95% CI, 1.574 to 7.223), bladder abnormality (HR, 12.209; 95% CI, 3.616 to 41.225) were significantly associated with the occurrence of surgery. The interobserver agreement was moderate to almost perfect agreement for US features (κ=0.564-0.898) and substantial for final UTD grades (κ=0.716). CONCLUSION The UTD classification system is reliable and appropriately stratifies the risk of surgical intervention.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence to: Hee Mang Yoon, MD, PhD, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel. +82-2-3010-0906 Fax. +82-2-476-4719 E-mail: ,
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abimbola O, Smith BD, Gurjar M, Ross SS. Outcomes of intermediate-risk hydronephrosis in pediatric patients. J Pediatr Urol 2022; 19:196.e1-196.e6. [PMID: 36473783 DOI: 10.1016/j.jpurol.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Hydronephrosis is a common antenatal diagnosis and is present in approximately 1-5% of pregnancies. The urinary tract dilation (UTD) classification system was introduced in 2014 and stratifies post-natal hydronephrosis risk into three groups: low-risk (P1), intermediate-risk (P2), and high-risk (P3). Recommendations for P3 hydronephrosis have been established, whereas those for P1 and P2 UTD are often left to the discretion of providers with P1 considered low-grade and less concerning significant pathology. Given the obscure nature of P2 hydronephrosis, we sought to determine the natural history and outcomes of pediatric patients with P2 hydronephrosis within a single institution. MATERIALS AND METHODS Children <18 years old diagnosed with hydronephrosis between January 2015 and December 2018 were identified by ICD-9 and ICD-10 codes. Patients with P1 hydronephrosis, P3 hydronephrosis, known vesicoureteral reflux, complex anomalies (ex. Posterior urethral valve), neurological impairments, neurogenic bladder secondary to spinal abnormalities, and <6 months of follow-up were excluded. The development of urinary tract infection (UTI; ≥100 000 CFU/mL of bacterial growth, UA > 10 WBCs/hpf with fever >38C), need for surgical intervention (impaired renal function, worsening hydronephrosis, and/or delayed drainage on diuretic renography), and stability of hydronephrosis were collected retrospectively. RESULTS Eighty-seven patients [105 renal units (RU)] were included. Twenty-six patients (30%) were female and 61 (70%) were male. Of the male patients, 30 (49%) of them were circumcised. The median age at initial evaluation was 1 month, and the median duration of follow-up was 13 months. Thirty-four (32%) RU had complete resolution, 24 (23%) improved to P1 hydronephrosis, 33 (31%) remained stable, and 14 (13%) progressed to P3 hydronephrosis. The median duration to resolution and improvement was 8.5 months and 5 months, respectively. Eleven (11%) RU required surgical intervention, 10 of which underwent pyeloplasty, with a median duration to intervention of 9 months. Fifty-five patients (63%) received antibiotic prophylaxis (amoxicillin or sulfamethoxazole-trimethoprim) for a median duration of 5 months. Nine patients (10%) developed a UTI, 3 of which were taking antibiotic prophylaxis at the time of infection. CONCLUSIONS Intermediate-risk hydronephrosis diagnosed in the pediatric population will either improve, resolve, or remain stable during 1-year follow-up in 87% of RU. Only 11% of RU required surgical intervention, and 19% of patients developed a UTI in the absence of antibiotic prophylaxis. These findings will assist with counseling parents concerning the importance of follow-up imaging and monitoring for UTI. However, the low risk of surgical intervention is encouraging and should be discussed with the children's caretakers.
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Affiliation(s)
- Obafunbi Abimbola
- Department of Urology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Benjamin D Smith
- Department of Radiology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Megan Gurjar
- Department of Urology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Sherry S Ross
- Department of Urology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Tan J, Yu Z, Ling X, Qiu G, Yang X, Tang Y, Yang D, Yang M, Gao F. Main Pathological Changes of Benign Ureteral Strictures. Front Med (Lausanne) 2022; 9:916145. [PMID: 35872768 PMCID: PMC9300898 DOI: 10.3389/fmed.2022.916145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo identify the pathological classification of benign ureteral strictures according to the histological features and explore the relationship between various pathological types and inflammatory cells, fibroblasts, and collagen.Patients and MethodsThirty one specimens from patients diagnosed with ureteral strictures between 2013 and 2021 were included and classified according to the histopathological characteristics. The number of fibroblasts and inflammatory cells was counted, and the proportion of type I and type III collagen in ureteral stricture tissues was detected by picrosirius red staining.ResultsWe identified three types of benign ureteral strictures in 31 specimens: inflammatory cell infiltration (n = 10, 32%), fibroplasia (n = 14, 45%), and hyalinization (n = 7, 23%), with significant differences in obstruction history and hydronephrosis grades among the three types. The number of inflammatory cells (lymphocytes, neutrophils and eosinophils) was significantly lower in hyalinization ureteral strictures than in the other two types (p < 0.05). The number of foreign-body giant cells associated with foreign-body reactions increased significantly in suture-induced ureteral strictures (p < 0.05). Fibroplasia type had the largest number of fibroblasts, whereas the other two types had smaller numbers. The results of type I and III collagen analysis showed that type I and III collagen were the most abundant in hyalinization among all ureteral stricture types (p < 0.05). Compared to ureteral strictures, the content of type I and III collagen in atresia increased significantly (p < 0.05).ConclusionCommon pathological types of benign ureteral strictures include inflammatory cell infiltration, fibroplasia, and hyalinization. Changes in type I and III collagen, inflammatory cells, and fibroblasts in different pathological types may be related to the progression of ureteral strictures.
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Affiliation(s)
- Jiang Tan
- Department of Anatomy, Institute of Neuroscience, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Zhuoyuan Yu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Ling
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoping Qiu
- Department of Anatomy, Institute of Neuroscience, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Xin Yang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Tang
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
| | - Dong Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Yang
- Department of Anatomy, Institute of Neuroscience, College of Basic Medicine, Chongqing Medical University, Chongqing, China
- *Correspondence: Mei Yang,
| | - Fei Gao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Fei Gao,
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Nguyen HT, Phelps A, Coley B, Darge K, Rhee A, Chow JS. 2021 update on the urinary tract dilation (UTD) classification system: clarifications, review of the literature, and practical suggestions. Pediatr Radiol 2022; 52:740-751. [PMID: 34981177 DOI: 10.1007/s00247-021-05263-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
In 2014, a multidisciplinary consensus on the classification of pre- and postnatal urinary tract dilation (UTD classification) was developed. Its goal was to provide a standardized system for evaluating and reporting urinary tract dilation both in the prenatal and postnatal periods. In this review, we summarize insights learned from the implementation of the UTD classification system since its inception, providing clarifications on common points of confusion. In addition, we review current literature in the clinical validation of the UTD classification system to provide credence for its use in managing fetuses and children with urinary tract dilation.
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Affiliation(s)
- Hiep T Nguyen
- Banner Children's Specialist, Urology, Banner Desert Children's Hospital, 1432 S. Dobson Road, #501, Mesa, AZ, 85202, USA.
| | - Andrew Phelps
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Brian Coley
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kassa Darge
- Department of Radiology, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Audrey Rhee
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
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Melo FF, Vasconcelos MA, Mak RH, Silva ACSE, Dias CS, Colosimo EA, Silva LR, Oliveira MCL, Oliveira EA. Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury. Pediatr Nephrol 2022; 37:613-623. [PMID: 34453601 DOI: 10.1007/s00467-021-05254-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The grading of urinary tract dilatation (UTD) on postnatal sonography is a fundamental step to establish rational management for infants with antenatal hydronephrosis (ANH). The aim of this study was to compare the prediction accuracy of UTD grading systems for relevant clinical outcomes. In addition, we propose a refinement of the UTD classification by adding quantitative measurements and evaluate its impact on accuracy. METHODS Between 1989 and 2019, 447 infants diagnosed with isolated AHN were prospectively followed. The events of interest were surgical interventions and kidney injury. Comparison of performance of the grading systems and the impact on the accuracy of a modified UTD classification (including the size of the kidney parenchyma) was assessed by the area under the receiver-operating characteristic curve (AUC). RESULTS Of 447 infants, 131 (29%) underwent surgical intervention and 26 (5.8%) had developed kidney injury. The median follow-up time was 9 years (IQ range, 7-12 years). The performance for detecting the need for surgical intervention was excellent for all grading systems (AUC > 0.90). However, for predicting kidney injury, the modified UTD classification exhibited significant improvement in accuracy (AUC = 0.913, 95%CI, 0.883-0.937) as compared with UTD classification (AUC = 0.887, 95%CI, 0.854-0.915) (P = 0.027). CONCLUSIONS Our study confirms that the hydronephrosis grading systems provide excellent accuracy in discriminating patients who need surgical intervention among infants with AHN. Our findings suggest that the inclusion of kidney parenchymal thickness to UTD classification might increase the accuracy for predicting infants who may develop kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Fernanda F Melo
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Ana Cristina Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Cristiane S Dias
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ludmila R Silva
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Maria Christina L Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil. .,Visiting Scholar, Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
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Vincent K, Murphy HJ, Twombley KE. Urinary Tract Dilation in the Fetus and Neonate. Neoreviews 2022; 23:e159-e174. [PMID: 35229134 DOI: 10.1542/neo.23-3-e159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urinary tract dilation (UTD), previously known as hydronephrosis, is the most common congenital condition identified on prenatal ultrasonography. UTD can be physiologic and resolve spontaneously or can be caused by various congenital anomalies of the urinary tract, which can lead to renal failure if not treated properly. In 2014, a multidisciplinary consensus group established UTD definitions, a classification system, and a standardized scheme for perinatal evaluation. Various imaging modalities are available to help diagnose the cause of UTD in fetuses and neonates and to help identify those patients who may benefit from fetal or early postnatal intervention. In this article, we will review the diagnosis and quantification of antenatal and postnatal UTD based on the UTD classification system, outline the imaging studies available to both evaluateUTD and determine its cause, briefly review the most common causes of UTD in the fetus and neonate, outline management strategies for UTD including the role for fetal intervention and prophylactic antibiotics, and report on the outcome and prognosis in patients with UTD.
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Affiliation(s)
- Katherine Vincent
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Heidi J Murphy
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Katherine E Twombley
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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Comparison of Urinary Tract Dilatation and Society of Fetal Urology systems in the detection of vesicourethral reflux and renal scar. Pol J Radiol 2021; 86:e449-e454. [PMID: 34429792 PMCID: PMC8369818 DOI: 10.5114/pjr.2021.107609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The presence and degree of hydronephrosis is very important in the management of many diseases of the urinary tract. In this study, we aim to compare the sensitivity and specificity of 2 classification systems that are used for hydro-nephrosis grading in ultrasound, for reflux and scar detection. The classification systems were the Society of Fetal Urology (SFU) and Urinary Tract Dilatation (UTD). Material and methods Ultrasounds and dimercaptosuccinic acid scintigraphies (DMSA) of all patients who underwent voiding cystourethrogram (VCUG) due to urinary tract infection were examined retrospectively. DMSA was accepted for scar detection and VCUG for reflux detection as reference methods. SFU classification was used for hydronephrosis in ultrasound reports, and UTD classification was made over the reports. Sensitivity, specificity, and positive and negative predictive values of UTD and SFU classification systems for reflux and scar detection were calculated, and these 2 systems were compared. Results 103 (39%) of the patients were male and 162 (61%) were female. Pathologies were detected in 192 (35%) of 530 kidneys in ultrasound. In 110 (42%) of the children, reflux was detected in VCUG. Scars in DMSA were detected in only 16% (44) of 266 kidneys. Sensitivity, positive and negative predictive values of the UTD classification system were statistically significantly higher than the SFU system for scar and reflux detection (p < 0.01). Conclusions If we use the UTD system in ultrasounds of patients with urinary tract infections, children reported as UTD 0 may not need VCUG, which reduces radiation exposure to children and the cost of the diagnostic interventions.
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Singh N, Bansal V, Satoskar P, Faisal S. A Retrospective Analysis to Evaluate Role of the New UTD Classification System in Prenatal Prediction of Severity and Postnatal Outcome in Antenatally Diagnosed Urinary Tract Dilatation Abnormalities. J Obstet Gynaecol India 2021; 71:268-276. [PMID: 34408346 DOI: 10.1007/s13224-020-01416-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background/Purpose of the Study Foetal urinary tract dilation (UTD) abnormalities affect 1-5% of all pregnancies. However, exact incidence is difficult to estimate because of different terminologies used to define the condition and different grading systems to define its severity antenatally as well as postnatally worldwide. In order to overcome this problem, the new UTD classification system has been introduced in the year 2014 so as to have universal approach for diagnosis and management of UTD globally. Indian data about clinical utility of the UTD classification system and its role in prenatal prediction of severity of renal disease are lacking. The present study aims to investigate clinical utility of new UTD classification system in foetal UTD abnormalities and to evaluate the role of UTD classification system in antenatal prediction/prognostication of severity of UTD abnormalities. Methods We conducted a single-centre retrospective study between April 2014 and January 2017, which included 70 infants with antenatally diagnosed UTD delivered in our hospital and managed in our paediatric unit postnatally. Pre- and postnatal ultrasound findings were noted, and UTD-A and UTD-P classification were applied retrospectively in all cases as per criteria defined in the new UTD classification. Postnatal outcome in all cases was evaluated in terms of need for immediate postnatal urosurgical intervention, presence of persistent UTD pathology and severity of renal impairment in relation to their pre- and postnatal UTD A and P risk categories. Results None from UTD A1 risk group in the last prenatal scan showed significant postnatal UTD abnormality. In contrast to this, UTD A2-3 risk group in the last prenatal scan had persistent postnatal UTD pathology in 70% cases. All infants with abnormal postnatal UTD diagnosis were identified prenatally as UTD A2-3 (high risk). Nine infants (12.8%, n = 70) who needed urosurgical intervention postnatally were categorised as UTD A2-3 prenatally and UTD P3 postnatally. Conclusion We found increased frequency of complications and urosurgical interventions in all infants with antenatal UTD A2-3 grades in the last prenatal scan in comparison with those with UTD A1 grades who showed complete resolution (100%) postnatally. Antenatal UTD classification may be useful in antenatal prediction and prognostication of postnatal severity, especially in high-risk cases (i.e. UTD A2-3).
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Affiliation(s)
- Neha Singh
- Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra India
| | - Vandana Bansal
- Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra India
| | - Purnima Satoskar
- Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra India
| | - Shameel Faisal
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra India
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Zhang Y, Li J, Jiao JW, Tian Y. Comparative outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for pediatric kidney stones larger than 2 cm. Int J Urol 2021; 28:650-655. [PMID: 33754401 DOI: 10.1111/iju.14532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for pediatric kidney stones larger than 2 cm and to show the learning curves for the two procedures. METHODS A prospectively managed database containing pediatric patients with kidney stones larger than 2 cm from June 2014 to October 2019 was analyzed. The primary outcomes were the efficacy and safety of flexible ureteroscopy and mini-percutaneous nephrolithotomy. Data on patient demographics, treatment details, stone-free rate, and complication rate were collected and compared. Learning curves were generated to estimate the effect of the surgeon's experience on surgical outcomes. RESULTS The final analysis included 113 pediatric patients who underwent surgery for kidney stones on a total of 126 sides. The stone-free rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy were 80.9% (34/42) and 79.7% (67/84), respectively (P = 0.19). The complication rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy were 52.5% (21/40) and 27.4% (27/73), respectively (P = 0.01). When stone mass was considered, the stone-free rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy for stones with a high mass (>5000 HU*cm2 ) were 83.3% (20/24) and 55.5% (10/18), respectively (P = 0.04). The learning curves showed that the stone-free rates for both mini-percutaneous nephrolithotomy and flexible ureteroscopy increased with the accumulation of cases. A higher stone-free rate could be achieved after approximately 20 mini-percutaneous nephrolithotomy cases and after approximately 50 flexible ureteroscopy cases. CONCLUSIONS Flexible ureteroscopy has an acceptable stone-free rate and a lower complication rate than mini-percutaneous nephrolithotomy when treating pediatric kidney stones larger than 2 cm. Mini-percutaneous nephrolithotomy is more applicable to stones with a high mass. The stone-free rates achieved after both mini-percutaneous nephrolithotomy and flexible ureteroscopy could be improved with number of cases accumulated.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian Wei Jiao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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12
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Zhang Y, Li J, Zhang D, Jiao JW, Tian Y. Nomograms predicting the outcomes of endoscopic treatments for pediatric upper urinary tract calculi. Int J Urol 2020; 28:295-301. [PMID: 33368610 DOI: 10.1111/iju.14451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To demonstrate the efficacy and safety of mini-percutaneous nephrolithotomy, micro-percutaneous nephrolithotomy, and flexible ureteroscopy for pediatric upper urinary tract calculi and to develop nomograms predicting surgical outcomes. METHODS A prospectively managed database containing children who were diagnosed with upper urinary tract calculi and treated with mini-percutaneous nephrolithotomy, micro-percutaneous nephrolithotomy, and flexible ureteroscopy between June 2014 and April 2019 was analysed. Patient demographics, intraoperative data, stone characteristics, stone-free rate, and complication rate were analysed and compared. Nomograms predicting the postoperative stone-free rate and complication rate were established based on predictors, and internal validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit. RESULTS Forty-three children underwent mini-percutaneous nephrolithotomy on 56 sides in 47 operations, 30 children underwent micro-percutaneous nephrolithotomy on 30 sides in 30 operations, and 275 children underwent flexible ureteroscopy on 320 sides in 288 operations. The stone-free rates were 88.5% (282/320) for flexible ureteroscopy, 89.3% (50/56) for mini-percutaneous nephrolithotomy, and 90.0% (27/30) for micro-percutaneous nephrolithotomy (P = 0.94). And the complication rates were 19.8% (57/288), 36.2% (17/47), and 33.3% (10/30), respectively (P = 0.02). Nomograms based on stone characteristics, operation duration, and the physical condition of the child were shown to have good discrimination and calibration. The area under the curve of the models was 81% for stone-free rate and 73% for complication rate. The calibration curves showed that the nomogram might underestimate the probability of stone-free rate when the threshold was below 82% and might overestimate the risk of complication rate when the threshold was over 25%. The decision curves demonstrated that the Capital Medical University nomograms improved clinical risk prediction against threshold probabilities of stone-free rate ≤20% and complication rate ≤10%. CONCLUSIONS Both the percutaneous nephrolithotomy and flexible ureteroscopy procedures could have acceptable stone-free rates when treating pediatric stones. The Capital Medical University nomograms performed well in helping to predict stone-free and complication rates.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian Wei Jiao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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13
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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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Zhang Y, Wang X, Li J, Yian Y. Influence of Body Mass Index on the Surgical Outcomes of Flexible Ureteroscopy for Pediatric Upper Urinary Tract Aalculi-A Single Surgeon Experience. Urology 2020; 153:291-297. [PMID: 33227303 DOI: 10.1016/j.urology.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the association between body mass index (BMI) and surgical outcomes of flexible ureteroscopy (FURS) for pediatric upper urinary tract calculi and to estimate the influence of BMI percentile on the learning curve of pediatric FURS. MATERIALS AND METHODS We reviewed our prospectively maintained database containing children who had kidney or ureteral stones from June 2014 to April 2019. We calculated BMI and plotted it on the Centers for Disease Control and Prevention growth chart for sex and age to estimate BMI percentile. Patient demographics, intraoperative data, stone characteristics, stone-free rate (SFR), and complication rate (CR) were analyzed. Learning curves stratified by BMI percentile groups were generated. RESULTS The final analysis included 161 children, of whom 63 (39.1%) had upper body weight percentile (UBW), 64 (39.8%) had normal body weight percentile (NBW), and 34 (21.1%) had lower body weight percentile (LBW). The median stone burden of the 3 groups were 1.14 (IQR 0.50-3.41), 1.13 (IQR 0.70-3.14), and 0.95 (IQR 0.50-1.77), respectively (P = .17). The SFRs were 90.5% (57/63) in the UBW group, 81.2% (52/64) in the NBW group and 70.6% (24/34) in the LBW group (P = .04). The CRs were 15.9% (10/63), 21.9% (14/64), and 29.4% (10/34), respectively (P = .29). The learning curves showed that the SFR of FURS could be improved after about 100 cases. And decreasing BMI could steepen the learning curve of SFR. CONCLUSIONS BMI is associated with the SFR of FURS. LBW children had the lowest SFR compared to UBW and NBW children. Lower BMI percentile makes the success of FURS more challenging.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - XiaoChuan Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ye Yian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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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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16
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Nelson CP, Lee RS, Trout AT, Servaes S, Kraft KH, Barnewolt CE, Logvinenko T, Chow JS. The association of postnatal urinary tract dilation risk score with clinical outcomes. J Pediatr Urol 2019; 15:341.e1-341.e6. [PMID: 31164273 DOI: 10.1016/j.jpurol.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are limited data on the predictive value of the consensus urinary tract dilation (UTD) score with respect to subsequent clinical diagnoses. We sought to define the relationship between postnatal UTD risk score and clinical outcomes during childhood. METHODS Complete ultrasound image sets from a random selection of infants aged 0-90 days undergoing initial ultrasound at a single institution for prenatal hydronephrosis between 2012 and 2014 were assigned a UTD score by 1 pediatric urologist and 1 pediatric radiologist. Urinary tract dilation risk score was analyzed for association with a composite outcome comprising urinary tract infection, vesicoureteral reflux (VUR), ureteropelvic junction obstruction, non-refluxing megaureter (NRM), ureterocele, bladder outlet obstruction (BOO), and chronic kidney disease. Surgical intervention and resolution of UTD were evaluated separately. Descriptive and survival analyses were performed. RESULTS Urinary tract dilation scores for 494 subjects were P0 in 23.5%, P1 in 26.5%, P2 in 23.5%, and P3 in 26.5%. Seventy-four percent were male. Median age at initial imaging was 28 days; median follow-up was 19.8 months. The composite outcome occurred in 138 of 494 patients (27.9%) and varied significantly (p < 0.001) by UTD score: 11.2% for P0, 10.7% for P1, 29.3% for P2, and 58.8% for P3. On survival analysis (Summary Figure), higher UTD grade was significantly associated with the composite outcome (hazard ratio for P3 vs. P0 was 7.4 [95% CI: 3.44-15.92, p < 0.001]). Urinary tract infection and VUR diagnosis varied by UTD score (p = 0.03 and p < 0.001, respectively). Ureteropelvic junction obstruction was diagnosed (based on MAG3 results) in 6.3% of patients, 84% of whom were P3. Non-refluxing megaureter was diagnosed in 7.7%. Ureterocele and BOO were uncommon (1.4%, and 0.6%, respectively). Surgical intervention was also associated with UTD risk, with 46% of P3 undergoing surgery vs. 1% of P0, 1% of P1, and 6% of P2 (p < 0.001). Resolution of UTD occurred in 41% (median 10.1 months) and varied significantly by UTD risk (p < 0.001). DISCUSSION Urinary tract dilation risk score is associated with clinical events, although ascertainment bias may influence some of the differences in outcomes, particularly for VUR, because VCUG utilization varied by the UTD group. The lack of any significant difference in outcomes between patients with UTD P0 versus P1 suggests that the P1 category could be eliminated as it does not meaningfully distinguish between outcome risk. CONCLUSIONS Higher UTD risk scores are strongly associated with genitourinary diagnoses during the first two years of life.
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Affiliation(s)
- C P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA, USA.
| | - R S Lee
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA, USA
| | - A T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and Department of Radiology, University of Cincinnati Medical Center, Cincinnati OH, USA
| | - S Servaes
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA
| | - K H Kraft
- Department of Urology, CS Mott Children's Hospital, University of Michigan, Ann Arbor MI, USA
| | - C E Barnewolt
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston MA, USA
| | - T Logvinenko
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA, USA
| | - J S Chow
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston MA, USA
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Hurt L, Wright M, Demmler J, VanDerVoort J, Morris S, Brook F, Tucker D, Chapman M, Francis NA, Daniel R, Fone D, Brophy S, Paranjothy S. Mild-to-moderate renal pelvis dilatation identified during pregnancy and hospital admissions in childhood: An electronic birth cohort study in Wales, UK. PLoS Med 2019; 16:e1002859. [PMID: 31361739 PMCID: PMC6667131 DOI: 10.1371/journal.pmed.1002859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/21/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18-20 weeks gestation is an early indicator of renal pathology. The aim of this follow-up to the Welsh Study of Mothers and Babies was to assess the risk of hospital admission in children with mild-to-moderate antenatal RPD compared with children without this finding. We also examined how the natural history of the RPD (whether the dilatation persists in later pregnancy or postpartum) or its characteristics (unilateral versus bilateral) changed the risk of hospital admission. METHODS/FINDINGS This population-based cohort study included singleton babies born in Wales between January 1, 2009, and December 31, 2011 (n = 22,045). We linked ultrasound scan data to routinely available data on hospital admissions from the Patient Episode Database for Wales (PEDW). The outcome was a hospital admission for urinary tract causes (defined by an expert study steering group) in the first three years of life. We used Cox regression to model time to first hospital admission, according to whether there was evidence of RPD at the fetal anomaly scan (FAS) and/or evidence of dilatation in later investigations, adjusting for other predictors of admission. We used multiple imputation with chained equations to impute values for missing data. We included 21,239 children in the analysis. The risk of at least one hospital admission was seven times greater in those with RPD (n = 138) compared with those without (n = 21,101, conditional hazard ratio [cHR] 7.23, 95% confidence interval [CI] 4.31-12.15, p < 0.001). The risk of hospital admission was higher in children with RPD at the FAS and later dilatation (cHR 25.13, 95% CI 13.26-47.64, p < 0.001) and in children without RPD at the FAS who had later dilatation (cHR 62.06, 95% CI 41.10-93.71, p < 0.001) than in children without RPD (n = 21,057). Among children with RPD at the FAS but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (cHR 2.16, 95% CI 0.69-6.75, p = 0.185), except when the initial dilatation was bilateral (cHR 4.77, 95% CI 1.17-19.47, p = 0.029). Limitations of the study include small numbers in subgroups (meaning that these results should be interpreted with caution), that less severe outcomes (such as urinary tract infections [UTIs] managed in the community or in outpatients) could not be included in our analysis, and that obtaining records of radiological investigations later in pregnancy and postpartum was challenging. Our conclusions were consistent after conducting sensitivity analyses to account for some of these limitations. CONCLUSIONS In this large population-based study, children with RPD at the FAS had higher rates of hospital admissions when there was persistent dilatation in later pregnancy or postpartum. Our results can be used to improve counselling of parents and develop care pathways for antenatal screening programmes, including protocols for reporting and further investigation of RPD.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Melissa Wright
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Joanne Demmler
- Swansea University Medical School, Swansea, United Kingdom
| | - Judith VanDerVoort
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom
| | - Susan Morris
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom
| | - Fiona Brook
- Aneurin Bevan University Health Board, Caerleon, Newport, United Kingdom
| | - David Tucker
- Congenital Anomaly Register and Information Service, Singleton Hospital, Swansea, United Kingdom
| | - Maria Chapman
- Antenatal Screening Wales, Public Health Wales, Cardiff, United Kingdom
| | - Nick A. Francis
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Rhian Daniel
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David Fone
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sinead Brophy
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
- * E-mail:
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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: 0.8] [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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Vasconcelos MA, Oliveira EA, Simões E Silva AC, Dias CS, Mak RH, Fonseca CC, Campos APM, Steyerberg EW, Vergouwe Y. A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract. Front Pediatr 2019; 7:120. [PMID: 31001505 PMCID: PMC6454042 DOI: 10.3389/fped.2019.00120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to identify predictive factors and develop a model to assess individualized risk of postnatal surgical intervention in patients with antenatal hydronephrosis. This is a retrospective cohort study of 694 infants with prenatally detected congenital anomalies of kidney and urinary tract with a median follow-up time of 37 months. The main event of interest was postnatal surgical intervention. A predictive model was developed using Cox model with internal validation by bootstrap technique. Of 694 patients, 164 (24%) infants underwent surgical intervention in a median age of 7.8 months. Predictors of the surgical intervention in the model were: baseline glomerular filtration rate, associated hydronephrosis, presence of renal damage and the severity of renal pelvic dilatation. The optimism corrected c statistic for the model was 0.84 (95%CI, 0.82-0.87). The predictive model may contribute to identify infants at high risk for surgical intervention. Further studies are necessary to validate the model in patients from other settings.
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Affiliation(s)
- Mariana A Vasconcelos
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Eduardo A Oliveira
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - Ana Cristina Simões E Silva
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,National Institute of Science and Technology (INCT) of Molecular Medicine, Belo Horizonte, Brazil
| | - Cristiane S Dias
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - Carolina C Fonseca
- Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Paula M Campos
- Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Yvonne Vergouwe
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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Capolicchio JP, Braga LH, Szymanski KM. Canadian Urological Association/Pediatric Urologists of Canada guideline on the investigation and management of antenatally detected hydronephrosis. Can Urol Assoc J 2017; 12:85-92. [PMID: 29319488 DOI: 10.5489/cuaj.5094] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Luis H Braga
- McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Konrad M Szymanski
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
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21
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Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ. Society for Fetal Urology Classification vs Urinary Tract Dilation Grading System for Prognostication in Prenatal Hydronephrosis: A Time to Resolution Analysis. J Urol 2017; 199:1615-1621. [PMID: 29198999 DOI: 10.1016/j.juro.2017.11.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The Urinary Tract Dilation grading system for prenatal hydronephrosis was introduced to address potential shortcomings of the Society for Fetal Urology classification. Hydronephrosis resolution is an important patient outcome and is frequently discussed during family counseling. We compared these 2 grading systems and their ability to predict time to hydronephrosis resolution. MATERIALS AND METHODS We prospectively screened 855 patients with prenatal hydronephrosis due to ureteropelvic junction obstruction-like hydronephrosis, nonrefluxing primary megaureter or vesicoureteral reflux between 2009 and 2015. Of the patients 454 were excluded due to surgery, late referral, absence of postnatal dilatation or presence of other anomalies, resulting in 401 eligible patients (of whom 81% were male) to be included for analyses. Hydronephrosis grades collected at baseline and last followup were compared to identify resolution trends through time. Hydronephrosis resolution was defined as renal pelvis anteroposterior diameter 10 mm or less at last followup. Time to resolution was analyzed using Cox proportion regression. RESULTS Of 401 patients 328 (82%) had resolution during a mean ± SD followup of 24 ± 18 months (maximum 107). Cumulative resolution rate at 3 years was 98% for Society for Fetal Urology grade I hydronephrosis, 87% for grade II, 76% for grade III and 57% for grade IV. The 3-year hydronephrosis resolution rate was 90% for Urinary Tract Dilation postnatal grade 1 (low risk), 81% for grade 2 (intermediate risk) and 71% for grade 3 (high risk). CONCLUSIONS Patients with distinctive baseline hydronephrosis grades (classified by Society for Fetal Urology or Urinary Tract Dilation system) had significantly different resolution times for hydronephrosis (p <0.001). Counseling families regarding time to resolution of prenatal hydronephrosis should remain the same whether using Society for Fetal Urology or Urinary Tract Dilation grading system.
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Affiliation(s)
- Luis H Braga
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Melissa McGrath
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Office of Surgical Research Services, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kizanee Jegatheeswaran
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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22
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Classification of pediatric urinary tract dilation: the new language. Pediatr Radiol 2017; 47:1109-1115. [PMID: 28779200 DOI: 10.1007/s00247-017-3883-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/27/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
The multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system) was created to unify the language used to describe urinary tract dilation on antenatal and postnatal ultrasound examinations and thereby facilitate communication among providers and improve outcomes research. The background and new classification system are described in this review, with imaging examples.
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Rickard M, Easterbrook B, Kim S, Farrokhyar F, Stein N, Arora S, Belostotsky V, DeMaria J, Lorenzo AJ, Braga LH. Six of one, half a dozen of the other: A measure of multidisciplinary inter/intra-rater reliability of the society for fetal urology and urinary tract dilation grading systems for hydronephrosis. J Pediatr Urol 2017; 13:80.e1-80.e5. [PMID: 27916387 DOI: 10.1016/j.jpurol.2016.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The urinary tract dilation (UTD) classification system was introduced to standardize terminology in the reporting of hydronephrosis (HN), and bridge a gap between pre- and postnatal classification such as the Society for Fetal Urology (SFU) grading system. Herein we compare the intra/inter-rater reliability of both grading systems. MATERIALS AND METHODS SFU (I-IV) and UTD (I-III) grades were independently assigned by 13 raters (9 pediatric urology staff, 2 nephrologists, 2 radiologists), twice, 3 weeks apart, to 50 sagittal postnatal ultrasonographic views of hydronephrotic kidneys. Data regarding ureteral measurements and bladder abnormalities were included to allow proper UTD categorization. Ten images were repeated to assess intra-rater reliability. Krippendorff's alpha coefficient was used to measure overall and by grade intra/inter-rater reliability. Reliability between specialties and training levels were also analyzed. RESULTS Overall inter-rater reliability was slightly higher for SFU (α = 0.842, 95% CI 0.812-0.879, in session 1; and α = 0.808, 95% CI 0.775-0.839, in session 2) than for UTD (α = 0.774, 95% CI 0.715-0.827, in session 1; and α = 0.679, 95% CI 0.605-0.750, in session 2). Reliability for intermediate grades (SFU II/III and UTD 2) of HN was poor regardless of the system. Reliabilities for SFU and UTD classifications among Urology, Nephrology, and Radiology, as well as between training levels were not significantly different. DISCUSSION Despite the introduction of HN grading systems to standardize the interpretation and reporting of renal ultrasound in infants with HN, none have been proven superior in allowing clinicians to distinguish between "moderate" grades. While this study demonstrated high reliability in distinguishing between "mild" (SFU I/II and UTD 1) and "severe" (SFU IV and UTD 3) grades of HN, the overall reliability between specialties was poor. This is in keeping with a previous report of modest inter-rater reliability of the SFU system. This drawback is likely explained by the subjective interpretation required to assign grades, which can be impacted by experience, image quality, and scanning technique. As shown in the figure, which demonstrates SFU II (a) and SFU III (b), as assigned by a radiologist, it is possible to make an argument that either of these images can be classified into both categories that were observed during the grading sessions of this study. CONCLUSION Although both systems have acceptable reliability, the SFU grading system showed higher overall intra/inter-rater reliability regardless of rater specialty than the UTD classification. Inter-rater reliability for SFU grades II/III and UTD 2 was low, highlighting the limitations of both classifications in regards to properly segregating moderate HN grades.
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Affiliation(s)
- Mandy Rickard
- McMaster Children's Hospital, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Bethany Easterbrook
- Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Department of Surgery, Division of Urology, Hamilton, Ontario, Canada
| | - Soojin Kim
- Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Nina Stein
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Steven Arora
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Jorge DeMaria
- McMaster Children's Hospital, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Department of Surgery, Division of Urology, Hamilton, Ontario, Canada; Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Armando J Lorenzo
- Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Hamilton, Ontario, Canada; The Hospital for Sick Children, Division of Urology, Toronto, Ontario, Canada
| | - Luis H Braga
- McMaster Children's Hospital, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Department of Surgery, Division of Urology, Hamilton, Ontario, Canada; Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada.
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Conversion and reliability of two urological grading systems in infants: the Society for Fetal Urology and the urinary tract dilatation classifications system. Pediatr Radiol 2017; 47:65-73. [PMID: 27725992 DOI: 10.1007/s00247-016-3721-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/03/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The urinary tract dilation (UTD) classification system was proposed in 2014. OBJECTIVE To evaluate the correspondence and reliability of two US grading systems for postnatal urinary tract dilatation in infants: the Society for Fetal Urology (SFU) and the UTD systems. MATERIALS AND METHODS We assessed 180 kidneys in infants younger than 1 year. Four radiologists assessed the kidneys twice using both the SFU system (grades 0 to 4) and the UTD system (grades normal, P1, P2, P3). The SFU system was re-categorized into SFU-A (grades 0, 1-2, 3, 4) and into SFU-B (grades 0-1, 2, 3, 4). The Cohen kappa statistic was used for estimating agreement of both UTD-SFU-A and UTD-SFU-B. RESULTS The Cohen kappa was significantly higher between UTD and SFU-B as compared to the UTD and SFU-A (0.75 vs. 0.50, P < 0.001). Intra-observer agreement was similar for the two grading systems (SFU 0.64-0.88 vs. UTD 0.48-0.92, P = 0.050-0.885). SFU grades 2 and 3 showed fair to moderate inter-observer agreement and corresponding UTD grades P1 and P2 showed moderate to substantial agreement. The overall inter-observer agreement was significantly higher for the UTD system than for the SFU system during the first assessment (95% confidence interval [CI]: right kidney, -0.069 to -0.062; left kidney, -0.048 to -0.043). CONCLUSION Correspondence between the systems was poor using a recommended re-categorization (SFU-A). An alternative re-categorization (SFU-B) was found to be more appropriate for establishing correspondence between the systems. Both systems were reliable, with good intra- and inter-observer agreement for the assessment of infant kidneys, but the UTD system had better inter-observer agreement.
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Chalmers DJ, Meyers ML, Brodie KE, Palmer C, Campbell JB. Inter-rater reliability of the APD, SFU and UTD grading systems in fetal sonography and MRI. J Pediatr Urol 2016; 12:305.e1-305.e5. [PMID: 27567594 DOI: 10.1016/j.jpurol.2016.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Antenatal hydronephrosis (ANH) is frequently detected on screening obstetric ultrasonography. Common ANH grading systems include the anterior-posterior diameter (APD) and the Society for Fetal Urology (SFU) grading system. Recent developments in the management of ANH include the use of fetal magnetic resonance imaging (MRI), and a new grading system - Urinary Tract Dilation (UTD). This study reviewed patients who underwent fetal MRI and ultrasound, and compared the grading systems across these imaging modalities. MATERIALS AND METHODS Patients who underwent paired fetal MRI and ultrasound studies between January 2012 and January 2014 were included. Two pediatric urologists and a pediatric radiologist reviewed the studies. Data collected included APD, SFU grade, and UTD grade. Fleiss' kappa statistic determined the inter-rater reliability (IRR) of the SFU and UTD grading within each imaging modality. Intra-class correlation assessed the consistency of the APD measurements. RESULTS Forty-seven patients and 88 renal units were evaluated. Median gestational age was 22 weeks. Kappa values of the SFU grading system indicated fair IRR for ultrasound imaging and moderate IRR for MRI imaging, while the UTD grading system reached moderate IRR for both. The IRR of the SFU grading system was improved with the use of MRI, while the UTD grading system was no different. The APD intraclass correlation coefficient improved significantly when measured by MRI. As the ultrasound SFU grade increased, the odds of the MRI SFU grade being scored higher increased by a factor of 3.7. There was no difference between ultrasound and MRI when using the UTD grading system. DISCUSSION This study was the first to assess the UTD system in a cohort of patients who underwent paired ultrasound and MRI studies. The results suggested that the UTD system might improve IRR, compared with the SFU system. The use of fetal MRI may improve the IRR of the SFU grading system. It also found that the proportion of SFU grades was affected by the imaging modality, raising the possibility that MRI 'overcalls' the SFU grade, compared with ultrasound. This difference was not observed using the UTD grading system. The most important limitation was the selection bias favoring complex pathology with severe ANH diagnosed at an early gestational age. CONCLUSIONS In this unique cohort, the UTD system improved IRR when compared to the SFU grading system. Fetal MRI improved the IRR of the SFU grading system, and improved the APD intraclass correlation. The SFU grading was likely to be higher when assessed by MRI vs ultrasound, but the UTD grade was not affected by the imaging modality.
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Affiliation(s)
- D J Chalmers
- Department of Surgery, Division of Urology, Maine Medical Center and Barbara Bush Children's Hospital, Portland, USA.
| | - M L Meyers
- Department of Radiology, Children's Hospital Colorado, Aurora, USA
| | - K E Brodie
- Department of Urology, Children's Hospital Colorado, Aurora, USA
| | - C Palmer
- Biostatistics, Epidemiology, Research and Design, Children's Hospital Colorado, Aurora, USA
| | - J B Campbell
- Department of Urology, Children's Hospital Colorado, Aurora, USA
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Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ. Associations of Initial Society for Fetal Urology Grades and Urinary Tract Dilatation Risk Groups with Clinical Outcomes in Patients with Isolated Prenatal Hydronephrosis. J Urol 2016; 197:831-837. [PMID: 27590478 DOI: 10.1016/j.juro.2016.08.099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE There are limited comparative data on the predictive value of the 2 most commonly used classification systems, that is SFU (Society for Fetal Urology) hydronephrosis grades and urinary tract dilatation risk groups, in regard to the future risk of surgical intervention and the development of febrile urinary tract infection. We explored this topic in infants with isolated hydronephrosis. MATERIALS AND METHODS After screening 938 patients with prenatal hydronephrosis from 2009 to 2016 we selected 322 patients with ureteropelvic junction obstruction-like hydronephrosis for study. Hydronephrosis grades were prospectively collected at baseline, surgery and last followup. Gender, circumcision status, antibiotic prophylaxis and renal pelvis anteroposterior diameter were captured. The primary outcome was pyeloplasty and the development of febrile urinary tract infection. Comparative analyses between SFU grades/urinary tract dilatation groups and the primary outcome were performed with the Fisher exact and log rank tests. RESULTS Mean ± SD age at presentation was 3.3 ± 2.6 months and mean followup was 22 ± 19 months. Pyeloplasty was performed in 32% of patients with SFU III/IV vs 31% with urinary tract dilatation 2/3. The rate of febrile urinary tract infection in patients with SFU III/IV was similar to that in those with urinary tract dilatation group 2/3 (8% vs 10%). Children with SFU III/IV showed a significantly higher rate of surgery than those with SFU I/II (32% vs 2%, p <0.01). Similar findings were seen when using urinary tract dilatation groups to compare patients at low risk (1) vs moderate/high risk (2/3). CONCLUSIONS Both grading systems equally allowed for proper risk stratification and prediction of clinical outcomes based on baseline ultrasound. They correctly separated most infants who underwent surgery or in whom febrile urinary tract infection developed from those who could be treated nonsurgically. Use of the new urinary tract dilatation classification should not affect how families of children with isolated hydronephrosis are counseled regarding surgical intervention and the risk of febrile urinary tract infection.
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Affiliation(s)
- Luis H Braga
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Melissa McGrath
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Office of Surgical Research Services, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kizanee Jegatheeswaran
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Wan JS. This Month in Pediatric Urology. J Urol 2016. [DOI: 10.1016/j.juro.2015.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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