ABSTRACT
Objective:
The need for surgery in high-grade hydronephrosis should be discussed in the literature. We evaluated the necessity of surgical treatment and follow-up results in cases with high grade antenatal hydronephrosis which may be due to ureteropelvic junction obstruction.
Methods:
Between 2010 and 2017, 79 (M: 62, F: 17) high grade antenatal hydronephrosis was followed by serial MAG3 scintigraphy, urinary ultrasound. The cases are, 10% or more loss of function, low functioning (<40%) obstruction at initial evaluation, no loss of function and increased hydronephrosis, non-obstructive hydronephrosis, resolution group. Pelvic AP diameter, parenchymal thickness were compared between the surgical and non-surgical groups.
Results:
Pelvic AP diameter function was lost and did not lose function but increased with hydronephrosis and it was significantly higher than the non-obstructive group in the surgical group (p=0.009, p=0.008). Parenchyma thickness was significantly lower in the surgical group than in the follow-up group. Pelvic AP was found as predictive ultrasonographic parameters for the surgery, 28 mm above the diameter and 5.8 mm below the parenchyma thickness.
Conclusion:
High-grade hydronephrosis is a concern for both the family physician and the physician. We think it would be useful to use these findings in informing the family.
References
1Liu DB, Armstrong WR 3rd, Maizels M. Hydronephrosis: prenatal and postnatal evaluation and management. Clin Perinatol 2014;41:661-78.
2Madden NP, Thomas DF, Gordon AC, Arthur RJ, Irving HC, et al. Antenatally detected pelviureteric junction obstruction. Is non-operation safe? Br J Urol 1991;68:305-10.
3Dhillon HK. Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol 1998;81 Suppl 2:39-44.
4Palmer LS, Maizels M, Cartwright PC, Fernbach SK, Conway JJ. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol 1998;159:222-8.
5Ismaili K, Hall M, Piepsz A, Alexander M, Schulman C, et al. Insights into the pathogenesis and natural history of fetuses with renal pelvis dilatation. Eur Urol 2005;48:207-14.
6Vemulakonda V, Yiee J, Wilcox DT. Prenatal hydronephrosis: postnatal evaluation and management. Curr Urol Rep 2014;15:430.
7Scalabre A, Demede D, Gaillard S, Pracros JP, Mouriquand P, et al. Prognostic Value of Ultrasound Grading Systems in Prenatally Diagnosed Unilateral Urinary Tract Dilatation. J Urol 2017;197:1144-9.
8Barbosa JA, Chow JS, Benson CB, Yorioka MA, Bull AS, et al. Postnatal longitudinal evaluation of children diagnosed with prenatal hydronephrosis: insights in natural history and referral pattern. Prenat Diagn 2012;32:1242-9.
9Coplen DE, Austin PF, Yan Y, Blanco VM, Dicke JM. The magnitude of fetal renal pelvic dilatation can identify obstructive postnatal hydronephrosis, and direct postnatal evaluation and management. J Urol 2006;176:724-7; discussion 727.
10Coelho GM, Bouzada MC, Pereira AK, Figueiredo BF, Leite MR, et al. Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol 2007;22:1727-34.
11Islek A, Guven AG, Koyun M, Akman S, Alimoglu E. Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed? Pediatr Nephrol 2011;26:1837-41.
12Braga LH, Mijovic H, Farrokhyar F, Pemberton J, DeMaria J, et al. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics 2013;131:e251-61.