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Influence of postnatal hydroureter in determining the need for voiding cystourethrogram in children with high-grade hydronephrosis
OBJECTIVE: To evaluate the utility of hydroureter (HU) to identify high-grade vesico-ureteric reflux (VUR) in patients with high-grade postnatal hydronephrosis (PH). PATIENTS AND METHODS: We retrospectively reviewed patients’ charts that had antenatal hydronephrosis from 2008 to 2014. Patients were...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992681/ https://www.ncbi.nlm.nih.gov/pubmed/29892489 http://dx.doi.org/10.1016/j.aju.2017.11.004 |
Sumario: | OBJECTIVE: To evaluate the utility of hydroureter (HU) to identify high-grade vesico-ureteric reflux (VUR) in patients with high-grade postnatal hydronephrosis (PH). PATIENTS AND METHODS: We retrospectively reviewed patients’ charts that had antenatal hydronephrosis from 2008 to 2014. Patients were excluded if they presented with febrile urinary tract infection (fUTI), neurogenic bladder, posterior urethral valve, multi-cystic dysplastic kidney, and multiple congenital malformations. We reviewed postnatal ultrasonography images and patients with Society of Fetal Urology (SFU) Grades 3 and 4 hydronephrosis with a renal pelvic antero-posterior diameter of ≥10 mm were included. The ureter was assessed and considered dilated if the ureteric diameter was ≥4 mm. The voiding cystourethrogram (VCUG) studies, fUTI incidence, and surgical reports were reviewed. RESULTS: Of the 654 patients reviewed, we included 148 patients (164 renal units) of whom 113 (76.4%) were male and 35 (23.6%) female. SFU Grade 3 PH was identified in 49% of the renal units, with the remaining 51% being SFU Grade 4. HU was found in 50/164 renal units and was not detected in the remaining 114 units. VUR was diagnosed in four units (3.5%) without HU (low-grade VUR); whilst it was detected in 19 units (38%) with HU (72.7% were high-grade VUR) (P < 0.001). VUR was diagnosed on the contralateral side in four/105 patients with PH without HU and diagnosed in 10/43 patients with PH with HU (P < 0.001). During a median follow-up of 25.9 months, none of the renal units that had VUR without HU developed UTI or had surgeries. CONCLUSION: Low-grade uncomplicated VUR was diagnosed in 3.5% of renal units without HU. Our results support limiting the use of VCUG to renal units with PH if associated with HU. |
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