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Pakkasjärvi N, Belov S, Jahnukainen T, Kivisaari R, Taskinen S. Stratifying Antenatal Hydronephrosis: Predicting High-Grade VUR Using Ultrasound and Scintigraphy. Diagnostics (Basel) 2024; 14:384. [PMID: 38396423 PMCID: PMC10888138 DOI: 10.3390/diagnostics14040384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Antenatal hydronephrosis (AHN), detected in approximately one percent of prenatal ultrasounds, is caused by vesicoureteral reflux (VUR) in 15-21% of cases, a condition with significant risks such as urinary tract infections and renal scarring. Our study addresses the diagnostic challenges of VUR in AHN. Utilizing renal ultrasonography and scintigraphy, we developed a novel scoring system that accurately predicts high-grade VUR, optimizing diagnostic precision while minimizing the need for more invasive methods like voiding cystourethrogram (VCUG); (2) Methods: This retrospective study re-analyzed renal ultrasonography, scintigraphy, and VCUG images from infants admitted between 2003 and 2013, excluding cases with complex urinary anomalies; (3) Results: Our analysis included 124 patients (75% male), of whom 11% had high-grade VUR. The multivariate analysis identified visible ureter, reduced renal length, and decreased differential renal function (DRF) as primary predictors. Consequently, we established a three-tier risk score, classifying patients into low, intermediate, and high-risk groups for high-grade VUR, with corresponding prevalences of 2.3%, 22.2%, and 75.0%. The scoring system demonstrated 86% sensitivity and 79% specificity; (4) Conclusions: Our scoring system, focusing on objective parameters of the visible ureter, renal length, and DRF, effectively identifies high-grade VUR in AHN patients. This method enhances diagnostics in ANH by reducing reliance on VCUG and facilitating more tailored and less invasive patient care.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, Helsinki University Hospital, 000290 Helsinki, Finland; (S.B.); (S.T.)
| | - Sofia Belov
- Department of Pediatric Surgery, Helsinki University Hospital, 000290 Helsinki, Finland; (S.B.); (S.T.)
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, Helsinki University Hospital, University of Helsinki, 000290 Helsinki, Finland;
| | - Reetta Kivisaari
- Department of Pediatric Radiology, Helsinki University Hospital, 000290 Helsinki, Finland;
| | - Seppo Taskinen
- Department of Pediatric Surgery, Helsinki University Hospital, 000290 Helsinki, Finland; (S.B.); (S.T.)
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Dorosiev E, Minova G, Mladenov B, Pelov T, Peev S. Neonatal urinoma associated with ascites in a newborn with a solitary kidney. Folia Med (Plovdiv) 2022; 64:998-1002. [PMID: 36876553 DOI: 10.3897/folmed.64.e69787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
Fetal urinomas are often diagnosed in prenatal ultrasonography. The etiology is usually an obstructive uropathy leading to hydronephrosis and increased intrarenal pressure putting future kidney function at risk. Rupture of pyelocaliceal system in such cases may lead to retroperitoneal urinoma or urinary ascites, sepsis, uraemia, and acute renal failure. On the other hand, this may serve as "pop-off valve" mechanism decreasing intrarenal pressure and protecting from definitive kidney function loss. We present a case of a newborn girl with a retroperitoneal urinoma, ascites, uraemia, and obstruction of a solitary right kidney, which was successfully treated minimally invasively through peritoneal and retroperitoneal drainage and intubation of the right ureter with a DJ stent shortly after birth.
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Affiliation(s)
- Emil Dorosiev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
| | | | | | - Teofil Pelov
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
| | - Stoyan Peev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
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Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
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Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Has R, Sarac Sivrikoz T. Prenatal Diagnosis and Findings in Ureteropelvic Junction Type Hydronephrosis. Front Pediatr 2020; 8:492. [PMID: 33014923 PMCID: PMC7498649 DOI: 10.3389/fped.2020.00492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
The widespread use of obstetric ultrasonography has increased the detection rate of antenatal hydronephrosis. Although most cases of antenatal hydronephrosis are transient, one third persists and becomes clinically important. Ultrasound has made differential diagnosis possible to some extent. Ureteropelvic junction type hydronephrosis (UPJHN) is one of the most common cause of persistent fetal hydronephrosis and occurs three times more in male fetuses. It is usually sporadic and unilateral. However, when bilateral kidneys are involved and presents with severe hydronephrosis, the prognosis may be poor. Typical ultrasound findings of UPJHN is hydronephrosis without hydroureter. The size and appearance of the fetal bladder is usually normal without thickening of the bladder wall. Several grading systems are developed and increasingly being used to define the severity of prenatal hydronephrosis and provides much more information about prediction of postnatal renal prognosis. If fetal urinary tract dilation is detected; laterality, severity of hydronephrosis, echogenicity of the kidneys, presence of ureter dilation should be assessed. Bladder volume and emptying, sex of the fetus, amniotic fluid volume, and presence of associated malformations should be evaluated. Particularly the ultrasonographic signs of renal dysplasia, such as increased renal parenchymal echogenicity, thinning of the renal cortex, the presence of cortical cysts, and co-existing oligohydramnios should be noticed. Unfortunately, there is no reliable predictor of renal function in UPJHN cases. Unilateral hydronephrosis cases suggesting UPJHN are mostly followed up conservatively. However, the cases with bilateral involvement are still difficult to manage. Timing of delivery is also controversial.
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Affiliation(s)
- Recep Has
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Ultrasound follow-up of an unusual giant urinoma in a newborn. J Ultrasound 2018; 21:65-68. [PMID: 29374393 DOI: 10.1007/s40477-016-0224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022] Open
Abstract
Urinoma, defined as an encapsulation of urine caused by urine extravasation into the perirenal space either through rupture of a calyceal fornix or a tear in the renal parenchyma, is an uncommon finding in prenatal diagnosis and the neonatal period. Urinoma can be associated with any urinary tract obstruction, or, as reported in several published cases, related to vesicoureteral reflux, kidney dysplasia, or complication arising during amniocentesis. We report on a newborn with a perinatal urinoma, with initial slight corpusculated fluid associated with nonobstructive and nonrefluxing megaureter, and no signs of kidney dysplasia. Close sonography follow-up of the urinoma allowed complex differential diagnoses, including cystic, septated, and solid perirenal masses, due to dissimilar and peculiar ultrasound images during urinoma evolution stages.
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Masson E, Scemama UA, Lignères MA, Benyamine A, Rossi P, Chaumoitre K, Granel B. [A left peri-renal infiltration]. Rev Med Interne 2017; 39:968-969. [PMID: 28734579 DOI: 10.1016/j.revmed.2017.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- E Masson
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - U-A Scemama
- Service d'imagerie médicale, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M-A Lignères
- Service d'imagerie médicale, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - A Benyamine
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - P Rossi
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - K Chaumoitre
- Service d'imagerie médicale, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - B Granel
- Service de médecine interne, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
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Zhang H, Yang H, Sun Y, Fan L, Zhang X. Prenatal drainage of fetal urinoma with polyhydramnios: a case report and literature review. J Matern Fetal Neonatal Med 2017; 31:264-266. [PMID: 28076981 DOI: 10.1080/14767058.2017.1281242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The appearance of fetal urinoma is rare in prenatal care, especially when associated with polyhydramnions. Many previous reports have concluded that the visualization of a prenatal urinoma is probably a sign of underlying renal dysplasia or poor function. Thus, the management of the reported cases, conservative treatment or uniroma drainage, has not been unified. In this paper, we present two cases of prenatally detected urinoma with prenatal drainage to improve the prognosis.
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Affiliation(s)
- Huijing Zhang
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Huixia Yang
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Yu Sun
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Lixin Fan
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Xiaoxiao Zhang
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
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Abstract
Fetal urinomas are a rare but important sonographic finding. Urinomas are peri‐renal collections of urine, formed after the rupture of the kidney secondary to an underlying urinary tract obstruction or trauma. Diagnosis antenatally is important for ongoing monitoring and postnatal follow up as their presence may indicate reduced or absent kidney function in the affected kidney.
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Affiliation(s)
- Danica Vress
- Fetal Medicine Unit Centenary Women's and Children's Hospital Canberra Australian Capital Territory Australia
| | - Meiri Robertson
- Fetal Medicine Unit Centenary Women's and Children's Hospital Canberra Australian Capital Territory Australia
| | - Debra Paoletti
- Fetal Medicine Unit Centenary Women's and Children's Hospital Canberra Australian Capital Territory Australia
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Oktar T, Salabaş E, Kalelioğlu İ, Atar A, Ander H, Ziylan O, Has R, Yüksel A. Fetal urinoma and prenatal hydronephrosis: how is renal function affected? Turk J Urol 2015; 39:96-100. [PMID: 26328088 DOI: 10.5152/tud.2013.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/20/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In our study, the functional prognosis of kidneys with prenatal urinomas were investigated. MATERIAL AND METHODS Between 2006 and 2010, fetal urinomas were detected in 19 fetuses using prenatal ultrasonography (US), and the medical records were reviewed retrospectively. Of the 19 cases, the follow-up data were available for 10 fetuses. The gestational age at diagnosis, prognosis of urinomas, clinical course and renal functions were recorded. Postnatal renal functions were assessed with renal scintigraphy. RESULTS Unilateral urinomas and increased parenchyma echogenicity in the ipsilateral kidney were detected in all of the fetuses. Of the 10 fetuses with follow-up data, the option of termination was offered in 6 cases of anhydramnios, including 3 cases with signs of infravesical obstruction (a possible posterior urethral valve (PUV) and poor prognostic factors and 3 cases with unilateral hydronephrosis and increased echogenicity in the contralateral kidney. Only one family agreed the termination. The other 5 fetuses died during the early postnatal period. The average postnatal follow-up period in the 4 surviving fetuses was 22.5 months (8-38 months). One patient with a PUV underwent ablation surgery during the early postnatal period. In the postnatal period, none of the 4 kidneys that were ipsilateral to the urinoma were functional on scintigraphic evaluation. The urinomas disappeared in 3 cases. Nephrectomy was performed in one case due to recurrent urinary tract infections. CONCLUSION In our study, no function was detected in the ipsilateral kidney of surviving patients with urinomas. Upper urinary tract dilatation accompanied by a urinoma is a poor prognostic factor for renal function.
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Affiliation(s)
- Tayfun Oktar
- Department of Urology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Emre Salabaş
- Department of Urology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - İbrahim Kalelioğlu
- Department of Gynecology and Obstetrics, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Arda Atar
- Department of Urology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Haluk Ander
- Department of Urology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Orhan Ziylan
- Department of Urology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Recep Has
- Department of Gynecology and Obstetrics, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Atıl Yüksel
- Department of Gynecology and Obstetrics, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, Cooper C, Crino J, Darge K, Herndon CDA, Odibo AO, Somers MJG, Stein DR. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10:982-98. [PMID: 25435247 DOI: 10.1016/j.jpurol.2014.10.002] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/08/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Urinary tract (UT) dilation is sonographically identified in 1-2% of fetuses and reflects a spectrum of possible uropathies. There is significant variability in the clinical management of individuals with prenatal UT dilation that stems from a paucity of evidence-based information correlating the severity of prenatal UT dilation to postnatal urological pathologies. The lack of correlation between prenatal and postnatal US findings and final urologic diagnosis has been problematic, in large measure because of a lack of consensus and uniformity in defining and classifying UT dilation. Consequently, there is a need for a unified classification system with an accepted standard terminology for the diagnosis and management of prenatal and postnatal UT dilation. METHODS A consensus meeting was convened on March 14-15, 2014, in Linthicum, Maryland, USA to propose: 1) a unified description of UT dilation that could be applied both prenatally and postnatally; and 2) a standardized scheme for the perinatal evaluation of these patients based on sonographic criteria (i.e. the classification system). The participating societies included American College of Radiology, the American Institute of Ultrasound in Medicine, the American Society of Pediatric Nephrology, the Society for Fetal Urology, the Society for Maternal-Fetal Medicine, the Society for Pediatric Urology, the Society for Pediatric Radiology and the Society of Radiologists in Ultrasounds. RESULTS The recommendations proposed in this consensus statement are based on a detailed analysis of the current literature and expert opinion representing common clinical practice. The proposed UTD Classification System (and hence the severity of the UT dilation) is based on six categories in US findings: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. The classification system is stratified based on gestational age and whether the UT dilation is detected prenatally or postnatally. The panel also proposed a follow-up scheme based on the UTD classification. CONCLUSION The proposed grading classification system will require extensive evaluation to assess its utility in predicting clinical outcomes. Currently, the grading system is correlated with the risk of postnatal uropathies. Future research will help to further refine the classification system to one that correlates with other clinical outcomes such as the need for surgical intervention or renal function.
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Affiliation(s)
- Hiep T Nguyen
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA.
| | - Carol B Benson
- Society of Radiologists in Ultrasounds (SRU), Reston, VA, USA; American College of Radiology (ACR), Reston, VA, USA
| | - Bryann Bromley
- American Institute of Ultrasound in Medicine (AIUM), Laurel, MD, USA
| | - Jeffrey B Campbell
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Jeanne Chow
- Society for Pediatric Radiology (SPR), Reston, VA, USA
| | - Beverly Coleman
- American College of Radiology (ACR), Reston, VA, USA; Society of Radiologists in Ultrasounds (SRU), Reston, VA, USA
| | - Christopher Cooper
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Jude Crino
- Society for Maternal-Fetal Medicine (SMFM), Washington, D.C., USA
| | - Kassa Darge
- Society for Pediatric Radiology (SPR), Reston, VA, USA
| | - C D Anthony Herndon
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Anthony O Odibo
- Society for Maternal-Fetal Medicine (SMFM), Washington, D.C., USA
| | | | - Deborah R Stein
- American Society of Pediatric Nephrology (ASPN), The Woodlands, TX, USA
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Yitta S, Saadai P, Filly RA. The fetal urinoma revisited. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:161-166. [PMID: 24371112 DOI: 10.7863/ultra.33.1.161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The fetal urinoma is a rare but important diagnosis, as it indicates substantial underlying obstruction with implications for the functionality of the affected kidney. This case series describes a single center's experience with the diagnosis and management of fetal urinomas. All 25 cases were diagnosed or referred to our medical center over an 11-year period. Most cases were secondary to either posterior urethral valves or ureteropelvic junction obstruction. Fetal interventions, including percutaneous drainage of the urinoma and cystoscopic alleviation of bladder outlet obstruction, were performed in 4 cases.
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Affiliation(s)
- Silaja Yitta
- Department of Women's Imaging University of California, 1600 Divisidero St, Room C-250, San Francisco, CA 94115 USA.
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