Outcomes of prenatally diagnosed moderate to severe hydronephrosis at a single institution.
Kathryn Trandem, MDPhD, Jeffery White, MD, Amay Singh, MS, Sheila Ryan, MS/JD, Duong Tu, MD, Chester Koh, MD, Nicolette Janzen, MD, Edmond T. Gonzales, MD, David Roth, MD, Abhishek Seth, MD.
Texas Children's Hospital, Houston, TX, USA.
The best treatment for neonates with prenatally diagnosed severe hydronephrosis (HN) secondary to ureteropelvic junction obstruction (UPJO) is still debated. Some argue for early operation to protect renal function, while others argue for operation only after compromised renal function, worsening HN, febrile UTI or symptomatology. We hypothesized that initial postnatal grade 4 HN secondary to UPJO would require operation more frequently than grade 3 HN and that most children would not require surgery.
A retrospective, single center chart review was performed on 202 patients with prenatally diagnosed HN and unilateral postnatal SFU grade 3 or 4 HN presenting between 2001-2015. Children with confounding urinary anomalies such as bilateral HN, lower urinary tract obstruction (LUTO) or vesicoureteral reflux (VUR) were excluded.
Two hundred two neonates were diagnosed with unilateral SFU grade 3 or 4 HN and renal scans consistent with UPJO. The majority was male (71%) and affected the left kidney (63%). On initial ultrasound, 39% of children presented with SFU grade 3 HN, and 61% presented with SFU grade 4 HN. An initial renal differential function 10% or greater was found in 13% of patients; they underwent immediate surgical correction. Eighty-seven percent underwent initial surveillance. With a mean follow-up of 44 months, 167 of 176 (95%) children who initially underwent observation progressed to surgery, with the majority occurring shortly after the first year (mean 17 months, median 7 months). There was no difference in operation rate between initial grade 3 or 4 HN (93 vs 96%, respectively). Indications given for surgery varied widely, with worsening HN (39%) or renal differential of greater than or equal to 10% (27%) being the most common. Postoperative complications occurred in 13% with urinary tract infection as most common.
The majority of children with prenatally diagnosed SFU grade 3 or 4 HN secondary to UPJO progressed to surgical correction (193 of 202, 96%). Surgical rate was no different whether the initial HN was grade 3 or grade 4.
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