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Purpose: The study aims to determine the possible improvement in cortical transit time (CTT) after surgery in infants with antenatally diagnosed ureteropelvic junction obstruction (UPJO), and investigate the correlation of CTT with preoperative renal function and parenchymal thickness. Patients and methods: Medical charts of 32 antenatally diagnosed children with UPJO operated on between 2014 and 2021 were reviewed. Patients' demographics, preoperative and postoperative anteroposterior diameter (APD), parenchymal thickness (PT) ratio, differential renal function (DF), drainage patterns and CTT were compared to determine operative benefit. Preoperative CTT of each patient was also grouped as severely delayed (> 6 min) and moderately delayed (3–5 min) and compared. The correlation between the preoperative CTT and preoperative DF and PT ratio was investigated. Results: The median age of the patients was 8.8 months (1–24 months). The CTT (mean: 6.8 ± 3.0 min) was prolonged before surgery and was significantly improved (mean 4.6 ± 1.0 min) after the operation (p < 0.001). A significant negative correlation was detected between the CTT and preoperative DF and between the CTT and preoperative PT ratio. Preoperative DF was found significantly impaired in patients within the severely prolonged CTT group compared to those within the moderately prolonged CTT group. Significant improvement in DF was detected in patients in the severely prolonged CTT group after surgery. Conclusion: CTT is a parameter to prove relief of obstruction in patients with antenatally diagnosed UPJO after surgery. CTT is negatively correlated with preoperative DF and PT ratio. Severely prolonged CTT may be considered to be an indication of early surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the urinary caspase-3 and cytochrome c levels in patients with unilateral antenatal hydronephrosis and to determine whether changes in urinary biomarker levels could be useful for both predicting the need for surgical intervention due to ureteropelvic junction obstruction (UPJO) and postoperative surgical success. Methods: Sixty-five children with a history of unilateral antenatal hydronephrosis and postnatal anteroposterior diameter ≥ 10 mm were included in this prospective case–control study between January 2013 and December 2021. The obstruction group consisted of 33 patients (28 boys, 84.8%) who underwent open dismembered pyeloplasty due to UPJO. The non-obstructive dilatation (NOD) group consisted of 32 patients (27 boys, 84.4%) with stable or improving hydronephrosis and no significant reduction in ipsilateral split renal function during follow-up, whereas 34 healthy children were enrolled in the study as a control group. Urinary urinary caspase-3 and cytochrome c levels using ELISA were measured. Results: The median preoperative urinary caspase-3 level was significantly higher in the obstruction group when compared to the NOD group (4.82 ng/mgCr vs. 2.61 ng/mgCr, p = 0.013) as well as the control group (4.82 ng/mgCr vs. 1.72 ng/mgCr, p = 0.002). In the postoperative period, urinary caspase-3 levels significantly decreased compared to preoperative measurements (4.82 ng/mgCr vs. 2.51 ng/mgCr, p = 0.006) and became similar to the control group (2.51 ng/mgCr vs. 1.72 ng/mgCr, p = 0.422). On the other hand, no significant differences were observed in urinary cytochrome c levels between the groups. All patients who underwent pyeloplasty achieved postoperative resolution in hydronephrosis and improved drainage on MAG-3, so none of the patients required re-do pyeloplasty. Postoperative decrease in caspase-3 level was found to be compatible with adequate urine drainage on MAG-3 scan. The cut-off value of urinary caspase-3 to predict patients requiring pyeloplasty was found to be 3.31 ng/mg creatinine with 63.6% sensitivity, 62.5% specificity (AUC = 0.679). In the multivariable analysis, urinary caspase-3 level (OR: 1.653, p = 0.019), anteroposterior pelvic diameter (OR: 1.401, p = 0.001), and split renal function on MAG-3 (OR: 1.277, p = 0.011) were found to be independent factors in determining patients who require surgery. Conclusion: Based on our preliminary findings, urinary caspase-3 levels could be a useful biomarker not only for predicting the need for surgical intervention but also for determining the postoperative surgical success in children with UPJO. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the Society of Fetal Urology (SFU) guidelines, the anteroposterior pelvic diameter (APD), and the urinary tract dilation (UTD) classification criteria for predicting the prognosis of antenatal hydronephrosis (AH). Materials and Methods: This was a retrospective analysis of the relationship among the three classification criteria and their contribution to the diagnosis and prognosis of possible AH in a cohort of neonates. Results: This study was a retrospective review of 290 neonates. The mean age was 16.4 ± 9.0 days, and 33% of the study population comprised female babies. An image review demonstrated that 35% of the patients had severe vesicoureteral reflux (VUR), 22% exhibited severe obstruction, 40% had transient hydronephrosis, and 9% required surgery. The antenatal SFU grading criteria demonstrated a significant relationship with severe obstruction, and the postnatal SFU grading was related to the severity of VUR. The highest sensitivity for the presence of VUR for surgical intervention was obtained for prenatal SFU-1 (100%). The highest specificity was for prenatal SFU-4 (96%) for the presence of VUR, prenatal SFU-4 (99%), and postnatal SFU-4 (94%) for surgical intervention. Conclusion: No reliable sonographic findings were found to predict VUR or severe ureteropelvic junction obstruction. The SFU grading during the postnatal period may predict VUR with low sensitivity and specificity. However, all three classification criteria contributed to the evaluation of the need for treatment in this cohort. [ABSTRACT FROM AUTHOR]

Background: Antenatal hydronephrosis (ANH) is a common prenatal finding that requires careful evaluation to determine appropriate management strategies. The variability in outcomes underscores the need for refined diagnostic and monitoring protocols to differentiate between cases necessitating intervention and those likely to resolve spontaneously. Materials and Methods: A prospective clinical study was conducted involving 150 pregnant women diagnosed with ANH between gestational weeks 18 to 24. Prenatal ultrasounds were performed at regular intervals to monitor renal pelvic dilatation. Postnatal evaluations included renal ultrasound, voiding cystourethrography, and nuclear renal scans to assess renal function and identify associated anomalies. Management decisions were based on standardized criteria including degree of hydronephrosis, presence of associated anomalies, and renal function. Results: Of the 150 cases, 80 (53.3%) resolved spontaneously during the prenatal period, while 70 (46.7%) required postnatal intervention. Among the intervention group, 45 cases (64.3%) required surgical correction for persistent hydronephrosis or associated anomalies, while the remaining 25 cases (35.7%) were managed conservatively with close monitoring. Arbitrarily, the mean anteroposterior renal pelvic diameter (APRPD) in the resolved group was 5.2 mm, compared to 10.6 mm in the intervention group. The median postnatal follow-up duration was 24 months. Conclusion: This study highlights the importance of systematic evaluation and monitoring in managing ANH. While a significant proportion of cases resolve spontaneously, a careful assessment of associated anomalies and renal function is crucial in identifying cases requiring intervention. The arbitrary APRPD values presented underscore the potential for establishing diagnostic thresholds to guide clinical decision-making. Refinement of treatment protocols based on such parameters can improve outcomes and reduce unnecessary interventions in infants with ANH.

(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. [ABSTRACT FROM AUTHOR]

Objective: We aimed to identify clinical and radiological predictors of the need for surgical intervention in infants with antenatally detected UPJO. Material and methods: We prospectively followed infants born with antenatally diagnosed ureteropelvic junction obstruction (UPJO) presented at our outpatient clinics for evidence of obstructive injury with a standard protocol with ultrasonography and renal scintigraphy. Indications for surgery included progression of hydronephrosis on serial examinations, initial differential renal function (DFR) ⩽35% or >5% loss in sequential studies, and febrile urinary tract infection (UTI). Univariate and multivariate analyses were utilized to define the predictors for surgical intervention, while the appropriate cut-off value of the initial Anteroposterior diameter (APD) was determined using the receiver operator curve analysis. Results: Univariate analysis revealed a significant association between surgery, the initial APD, cortical thickness, Society for Fetal Urology grade, UTD risk group, initial DRF, and febrile UTI (p -value < 0.05). No significant association between surgery and sex or side of the affected kidney (p -value 0.91 and 0.38, respectively). On multivariate analysis, the initial APD, initial DRF, obstructed renographic curve, and febrile UTI (p -value < 0.05) were the only independent predictors for surgical intervention. An initial APD of 23 mm can predict surgical requirement, with a specificity of 95% and sensitivity of 70%. Conclusion: For antenatally diagnosed UPJO, the APD value (at the age of 1 week), DFR value (at the age of 6–8 weeks), and febrile UTI during follow-up are significant and independent predictors of the need for surgical intervention. APD, when used with a cut-off value of 23 mm, is associated with high specificity and sensitivity for predicting surgical need. [ABSTRACT FROM AUTHOR]

Circumcision has been reported to reduce the risk of urinary tract infections (UTIs) in boys with antenatal hydronephrosis (HN). Our aim was to compare the incidence of UTIs in circumcised vs. uncircumcised boys with antenatal HN by conducting a systematic review and meta-analysis. A comprehensive search was performed until December 2022. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included: UTIs, continuous antibiotic prophylaxis (CAP) use, renal outcomes, and circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis were performed. Twenty-three studies describing 9093 boys with antenatal HN were identified, including 4677 uncircumcised and 4416 circumcised boys. Overall effect estimates demonstrate that circumcised boys have significantly reduced odds of developing any UTI [OR 0.26, 95%CI 0.21, 0.32; p < 0.001]]. In addition, there a significantly reduced odds of developing UTI when circumcised and on CAP [OR 0.19, 95% CI 0.13, 0.30; p < 0.001]. When stratifying by etiology, circumcision reduced the odds of UTI in boys with isolated HN [OR 0.33, 95% CI 0.16, 0.68; p = 0.003], vesicoureteral reflux [OR 0.23, 95% CI 0.13, 0.42; P < 0.00001], or with posterior urethral valves [OR 0.29, 95% CI 0.13, 0.64; p = 0.002]. Circumcision reduces the incidence of UTIs in boys with antenatal HN. This review is limited by the varied definitions of UTIs and inconsistent reporting on HN etiology, renal outcomes, and circumcision complications. Circumcision should be considered in boys with antenatal HN to prevent the risk of developing UTI. Further research is warranted to individualize the prophylactic role of circumcision for patients with HN. [ABSTRACT FROM AUTHOR]

Background: To determine the outcome of antenatally detected hydronephrosis in the post natal period. Objectives: To follow up all cases of Antenatally diagnosed hydronephrosis postnatally to determine the time course until spontaneous resolution of antenatal hydronephrosis and to identify the causes of hydronephrosis persisting in the postnatal period which requires early intervention. Materials and Methods: A total of 109 children with antenatal hydronephrosis were followed up with timely ultrasonography and other investigations(wherever necessary and also making a note on the various grades of hydronephrosis and their outcomes in postnatal life. Results: A total of 109 children with antenatal hydronephrosis were followed up in the current study. It was observed that most of the cases in our study were males with a M:F ration of 2.4:1. The most common cause of antenatal HUN were transient HUN(81%) followed by PUJ(10%) and VUR(3.7%).There was an increase in the number of children who resolved in the postnatal period as noted as 13.8%(15/109) children by day 7,57.8%(63/109) children by 1st month, 79.84%(87/109) children by 6th month and 87.2%(95/109)cases by 1st year. The risk of postnatal pathology increases with the severity of HN. Out of 109 babies with antenatal hydronephrosis 16 babies had persistent hydronephrosis at 1 year follow up. Conclusion: In foetuses with hydronephrosis detected in late second trimester, a thorough work up is required to rule out other anomalies and a follow up USS in third trimester can identify the progress of the same so that treatment and postnatal follow up can be planned accordingly.There is an increased risk of postnatal pathology as the grade of hydronephrosis increases. Most of the cases are managed conservatively as most of the resolve in the infancy with watchful waiting. [ABSTRACT FROM AUTHOR]

Background and Aim: Vesicoureteral reflux (VUR) as a known cause of urinary tract infection (UTI), renal scarring, and nephropathy, is congenital and often familial. The prevalence of VUR is unclear, although most cases of VUR resolves spontaneously, the management of children with VUR is controversial. The purpose of this review was to evaluate VUR in order to provide an update on management to improve its prognosis. Methods: The articles from several sources, including PubMed, Scopus, Embase, Google Scholar, Web of Science, and the Directory of Open Access Journals, were included. Conclusion: Due to various complications, VUR is very scary for patients or families, and special attention is needed. A challenge for pediatric nephrologists is the early diagnosis of VUR and the progressive complications of kidney disease. There is no internationally accepted, uniform, evidence-based algorithm for the assessment of reflux anywhere. [ABSTRACT FROM AUTHOR]

(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.

Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed for conducting this systematic review and meta-analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis. A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The incidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective effect against UTI with pooled OR of 0.28 (95% CI 0.23–0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17–0.32), obstructive hydronephrosis (pooled OR of 0.34; 95% CI 0.21–0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16–0.52). Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irrespective of the underlying cause of hydronephrosis. [ABSTRACT FROM AUTHOR]

Introduction: Antenatal ultrasound (US) is considered the gold standard tool to detect fetal anomalies during the antenatal period. However, its highly operator dependent and maybe affected with other variables. The aim of this study to compare discrepancy between antenatal and postnatal US diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT) and to evaluate the incidence of parent's consanguinity among those patients at King Abdulaziz Medical City – Western Region (KAMC-WR), as it may help changing the current practiced guidelines and applied protocols. Methods: This is an observational, retrospective, cross-sectional study, conducted at the Maternal Fetal Medicine Unit at KAMC-WR, reviewing antenatally detected CAKUT between the years 2009 and 2014. Utilizing the congenital anomalies database and using multiple databases collected the data. A data sheet was completed and divided into four sections, which consist of maternal data, antenatal data, delivery, and postnatal data. The analysis was performed using Statistical Package for Social Sciences program (Armonk, NY: IBM Corp). Results: We included 137 fetuses with renal anomalies in our study, with 17% perinatal mortality rate, and 13% loss of follow-up. Abnormal amniotic fluid was detected in 32%, and bilateral anomalies presented in 41% and it was most commonly seen in male fetuses. Added to that, 41% of the fetuses were product of consanguineous marriage and 11% had a history of other child with renal anomalies. However, the rate of discrepancy between antenatal and postnatal renal US findings was 24%. Finally, the most common anomaly found antenatally and confirmed postnatally was hydronephrosis disease spectrum (60.6%). Conclusion: There is a significant association between children with CAKUT and parents' consanguinity. Furthermore, the discrepancy rate for the detection of CAKUT between antenatal and postnatal US in our study was comparable to other international studies. Further prospective studies are recommended in this field for further understanding.

Aims: This study aims to determine the etiology of antenatal hydronephrosis (ANH) and predict need for surgical intervention based on antenatal renal pelvis anteroposterior diameter (APD). Materials and Methods: Combined prospective and retrospective study (2012–2018) of ANH cases with postnatal follow-up. Surgical intervention was correlated with the degree of hydronephrosis (HDN) and pelvis APD measured at the 2nd trimester, 3rd trimester, and postnatal 6-week follow-up. Results: One hundred and sixty-five patients were studied with a total of 219 ANH units. Transient HDN was seen in 116 units. Surgical intervention included pyeloplasty (n = 76), sub ureteric dextranomer injection (n = 8) and nephrectomy (n = 1). Chances of requiring surgery based on the degree of HDN in 2nd and 3rd trimester respectively were mild: 11.32% and 9.52%, moderate: 34.21% and 37.03% and severe: 85.71% and 86.27%. The mean increase in APD between the 2nd and 3rd trimester (n = 50) was lesser in conservatively managed (3.548 ± 4.219 mm) than surgically managed (8.261 ± 5.857 mm) patients (P = 0.002). In another subset (n = 37), the mean increase in APD between the 2nd trimester and postnatal period was less in conservatively managed (1.432 ± 0.612 mm) (P = 0.088) than surgically managed patients (12.91 ± 3.247 mm) (P = 0.004). The area under the receiver operating characteristic (ROC) curve showed that an APD of 8.2 mm in the 2nd trimester and 12.85 mm in the 3rd trimester correlated with the requirement of postnatal surgery. Conclusion: Apart from the degree of HDN, significant changes in APD between 2nd and 3rd trimester and cut off value suggested by the ROC curve will help during antenatal counseling with regard to requirement of postnatal surgery.

Introduction: Antenatal ultrasound (US) is considered the gold standard tool to detect fetal anomalies during the antenatal period. However, its highly operator dependent and maybe affected with other variables. The aim of this study to compare discrepancy between antenatal and postnatal US diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT) and to evaluate the incidence of parent's consanguinity among those patients at King Abdulaziz Medical City – Western Region (KAMC-WR), as it may help changing the current practiced guidelines and applied protocols. Methods: This is an observational, retrospective, cross-sectional study, conducted at the Maternal Fetal Medicine Unit at KAMC-WR, reviewing antenatally detected CAKUT between the years 2009 and 2014. Utilizing the congenital anomalies database and using multiple databases collected the data. A data sheet was completed and divided into four sections, which consist of maternal data, antenatal data, delivery, and postnatal data. The analysis was performed using Statistical Package for Social Sciences program (Armonk, NY: IBM Corp). Results: We included 137 fetuses with renal anomalies in our study, with 17% perinatal mortality rate, and 13% loss of follow-up. Abnormal amniotic fluid was detected in 32%, and bilateral anomalies presented in 41% and it was most commonly seen in male fetuses. Added to that, 41% of the fetuses were product of consanguineous marriage and 11% had a history of other child with renal anomalies. However, the rate of discrepancy between antenatal and postnatal renal US findings was 24%. Finally, the most common anomaly found antenatally and confirmed postnatally was hydronephrosis disease spectrum (60.6%). Conclusion: There is a significant association between children with CAKUT and parents' consanguinity. Furthermore, the discrepancy rate for the detection of CAKUT between antenatal and postnatal US in our study was comparable to other international studies. Further prospective studies are recommended in this field for further understanding. [ABSTRACT FROM AUTHOR]

To identify when obstetricians would deliver a fetus with antenatal hydronephrosis and normal liquor. Designed as snap-shot survey. Setting: Survey Monkey link. Population/sample were obstetrics and fetal medicine consultants who received the survey link via closed professional forums on the North West Coast Maternity Clinical Network, Facebook, and publicly on Twitter. Survey link publicised as above, obstetric consultants were asked at what gestation would they deliver a fetus with antenatal hydronephrosis and normal liquor; and what criteria would they use to make that decision. Main outcome measures were number of years in practice, gestation at delivery, anteroposterior diameter (APD) of renal pelvis. A total of 44/102 respondents (43%) would deliver prior to 40 weeks (median no. of years as consultant 10 years [IQR 5–17]) vs. those who would not (median years as consultant 5.5 [IQR 3–12]). Re APD threshold of delivery: 17 indicated delivery if the APD were 20 mm, 10 if it were 21–30 mm and 16 if it were >30 mm. Re gestation at which they would deliver: 13 indicated 37–38 weeks, 13 indicated 38–39 weeks and 17 indicated 39–40 weeks. Reasons selected for delivery before term were obstetric anxiety n=2, maternal request n=2, maternal anxiety n=2 and concern about fatal renal damage/renal damage n=34. A surprising number of respondents would consider early delivery of a fetus with hydronephrosis and normal liquor despite the lack of evidence of benefit. The evidence supporting term delivery means that early term delivery is only indicated for obstetric reasons in this scenario. [ABSTRACT FROM AUTHOR]

The advances in the utilization of USG in routine antenatal follow-up resulted in an increased diagnosis of antenatal hydronephrosis (ANH). This study was conducted to elaborate on the ANH's epidemiological and clinical characteristics, management, outcomes, and possible risk factors. Two hundred twenty-nine cases diagnosed with ANH were included during the antenatal follow-up at the Obstetrics and Gynecology Department of Ondokuz Mayıs University between 2004 and 2022. The ANH was a USG finding suggesting a hydronephrosis ≥7 mm. The epidemiological and clinical characteristics, risk factors, treatment and outcomes in the postnatal period were assessed retrospectively. About 75% of the cases were male, 8% were premature births, and the mean gestational week of diagnosis was 22±3 weeks. About 43.7% of mothers had urinary tract infections, and a family history of any kidney disease was present in 24.5% of mothers' and 20.5% of fathers' family histories.38.7% of cases underwent surgery. At the end of the 6-month follow-up, 37.3% had regressed, 38.7% of them had stable hydronephrosis, and 18.9% of them had normal findings in USG. Male gender increased gestational urinary tract infections, and parents' family histories for any kidney disease were found as possible risk factors for the development of ANH. However, close follow-up and timely intervention, including surgery, provide favourable outcomes in these cases. [ABSTRACT FROM AUTHOR]

Aims: This study aims to determine the etiology of antenatal hydronephrosis (ANH) and predict need for surgical intervention based on antenatal renal pelvis anteroposterior diameter (APD). Materials and Methods: Combined prospective and retrospective study (2012–2018) of ANH cases with postnatal follow-up. Surgical intervention was correlated with the degree of hydronephrosis (HDN) and pelvis APD measured at the 2nd trimester, 3rd trimester, and postnatal 6-week follow-up. Results: One hundred and sixty-five patients were studied with a total of 219 ANH units. Transient HDN was seen in 116 units. Surgical intervention included pyeloplasty (n = 76), sub ureteric dextranomer injection (n = 8) and nephrectomy (n = 1). Chances of requiring surgery based on the degree of HDN in 2nd and 3rd trimester respectively were mild: 11.32% and 9.52%, moderate: 34.21% and 37.03% and severe: 85.71% and 86.27%. The mean increase in APD between the 2nd and 3rd trimester (n = 50) was lesser in conservatively managed (3.548 ± 4.219 mm) than surgically managed (8.261 ± 5.857 mm) patients (P = 0.002). In another subset (n = 37), the mean increase in APD between the 2nd trimester and postnatal period was less in conservatively managed (1.432 ± 0.612 mm) (P = 0.088) than surgically managed patients (12.91 ± 3.247 mm) (P = 0.004). The area under the receiver operating characteristic (ROC) curve showed that an APD of 8.2 mm in the 2nd trimester and 12.85 mm in the 3rd trimester correlated with the requirement of postnatal surgery. Conclusion: Apart from the degree of HDN, significant changes in APD between 2nd and 3rd trimester and cut off value suggested by the ROC curve will help during antenatal counseling with regard to requirement of postnatal surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Most cases of antenatal the Society of Fetal Urology (SFU) grade 1or 2 hydronephrosis (HN) improve or resolve spontaneously with conservative treatment. However, there is no consensus on the duration of follow-up for cases of grade 1or 2 HN. The aim of this study was to determine the need for continuous follow-up period and new management of children with antenatal grade 1or 2 HN. Methods Subjects underwent ultrasonographic assessment for HN according to the SFU classification. We retrospectively evaluated 112 patients with postnatal grade 1 HN and 69 with grade 2 HN using abdominal ultrasonography between January 2010 and December 2017. We examined the change in HN grade on repeat ultrasonography. Kaplan–Meier method was used to show the effect of HN grade on the rate of HN changes. Results The mean follow-up duration was 44.9 ± 36.4 months (range 12–274). Initial SFU grade 1 HN disappeared in 47.0% of cases at 12 months, 66.4% at 24 months and 73.2% at 48 months. Initial SFU grade 2 HN showed improvement in grade in 74.7% of cases at 12 months, 88.3% at 24 months and 89.5% at 48 months. However, 14.6% of SFU grade 1 and 2.8% of SFU grade 2 cases increased in grade and of the 17 cases, 16 cases worsened within the first 6 months. No cases with increased grade required pyeloplasty. Initial disappearance and later reappearance of HN occurred in 40.5% of SFU grade 1 and 2 cases. The mean duration of later reappearance of HN was 39.1 ± 36.2 months (range 12–137). No cases showed reappearance of HN after more than 1 year. Conclusions Ultrasonography within the first 6 months was necessary for management of children with antenatal grade 1or 2 HN, because some patients showed worsening. After that, it is considered safe to spread the follow-up interval for stable cases. Most cases of grade 1or 2 HN resolved spontaneously, however a few cases reappeared within 1 year. Therefore, ultrasonography after 1 year was necessary in children with HN that spontaneously disappeared. The appropriate time to end the follow-up was considered to have been after 1 year or more has passed since the disappearance was confirmed.

Background: Antenatal hydronephrosis (ANH) is a common prenatal finding that requires careful evaluation to determine appropriate management strategies. The variability in outcomes underscores the need for refined diagnostic and monitoring protocols to differentiate between cases necessitating intervention and those likely to resolve spontaneously., Materials and Methods: A prospective clinical study was conducted involving 150 pregnant women diagnosed with ANH between gestational weeks 18 to 24. Prenatal ultrasounds were performed at regular intervals to monitor renal pelvic dilatation. Postnatal evaluations included renal ultrasound, voiding cystourethrography, and nuclear renal scans to assess renal function and identify associated anomalies. Management decisions were based on standardized criteria including degree of hydronephrosis, presence of associated anomalies, and renal function., Results: Of the 150 cases, 80 (53.3%) resolved spontaneously during the prenatal period, while 70 (46.7%) required postnatal intervention. Among the intervention group, 45 cases (64.3%) required surgical correction for persistent hydronephrosis or associated anomalies, while the remaining 25 cases (35.7%) were managed conservatively with close monitoring. Arbitrarily, the mean anteroposterior renal pelvic diameter (APRPD) in the resolved group was 5.2 mm, compared to 10.6 mm in the intervention group. The median postnatal follow-up duration was 24 months., Conclusion: This study highlights the importance of systematic evaluation and monitoring in managing ANH. While a significant proportion of cases resolve spontaneously, a careful assessment of associated anomalies and renal function is crucial in identifying cases requiring intervention. The arbitrary APRPD values presented underscore the potential for establishing diagnostic thresholds to guide clinical decision-making. Refinement of treatment protocols based on such parameters can improve outcomes and reduce unnecessary interventions in infants with ANH., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

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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). [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Antenatal hydronephrosis (AHN) is the most frequently detected abnormality by prenatal ultrasonography. Differential diagnosis of AHN includes a wide variety of congenital abnormalities of the kidney and urinary tract ranging from mild abnormalities such as transient or isolated AHN to more important ones as high-grade congenital vesicoureteral reflux or ureteropelvic junction obstruction. It is well known that the outcome depends on the underlying etiology. Various grading systems have been proposed for the classification of AHN on prenatal and postnatal ultrasonography. Mild isolated AHN represents up to 80% of cases, is considered to be benign, and majority of them resolve, stabilize, or improve during follow-up. Controversies exist regarding the diagnosis and management of some important and severe causes of AHN such as high-grade vesicoureteral reflux and ureteropelvic junction obstruction. Current approach is becoming increasingly conservative during diagnosis and follow-up of these patients with less imaging and close follow-up. However, there is still no consensus regarding the clinical significance, postnatal evaluation, and management of infants with AHN. The aim of this review is to discuss the controversies and provide an overview on the management of AHN. [ABSTRACT FROM AUTHOR]

Abstract Background Congenital hydronephrosis is a common foetal anomaly. There are numerous causes of hydronephrosis. The diagnosis of ureteral anomalies remains challenging. Congenital mid-ureteral stricture (CMS) is less common than proximal and distal strictures. In most cases involving CMS, this condition is diagnosed intra-operatively. The gold standard treatment is resection of the stenosed segment and ureteroureterostomy. Case presentation We report two patients with CMS which presented as antenatal hydronephrosis with postnatal workup showed a picture of pelviuretric junction obstruction which required surgical correction. Intraoperative retrograde pyelography (RGP) confirmed the diagnosis of mid ureteral stricture which make us to change the planned surgical intervention from pyeloplasty to excision of the ureteral stricture and ureteroureterostomy as definitive management. Conclusion CMS should be considered whenever proximal mega-ureter is an associated finding. Despite advanced radiological modalities, RGP remains the mainstay approach for diagnosing ureteral anomalies.

Background Antenatal hydronephrosis (ANH) affects ∼1–5% of pregnancies. The aim of this study was to develop a clinical prediction model of renal injury in a large cohort of infants with isolated ANH. Methods This is a longitudinal cohort study of 447 infants with ANH admitted since birth between 1989 and 2015 at a tertiary care center. The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension and chronic kidney disease (CKD). A predictive model was developed using a Cox proportional hazards model and evaluated by C -statistics. Results Renal pelvic dilatation (RPD) was classified into two groups [Grades 1–2 (n  = 255) versus Grades 3–4 (n  = 192)]. The median follow-up time was 6.4 years (interquartile range 2.8–12.5). Thirteen patients (2.9%) developed proteinuria, 6 (1.3%) hypertension and 14 (3.1%) CKD Stage 2. All events occurred in patients with RPD Grades 3–4. After adjustment, three covariables remained as predictors of the composite event: creatinine {hazard ratio [HR] 1.27, [95% confidence interval (CI) 1.05–1.56]}, renal parenchyma thickness at birth [HR 0.78(95% CI 0.625–0.991)] and recurrent urinary tract infections [HR 4.52 (95% CI 1.49–13.6)]. The probability of renal injury at 15 years of age was estimated as 0, 15 and 24% for patients assigned to the low-risk, medium-risk and high-risk groups, respectively (P < 0.001). Conclusion Our findings indicate an uneventful clinical course for patients with Society for Fetal Urology (SFU) Grades 1–2 ANH. Conversely, for infants with SFU Grades 3–4 ANH, our prediction model enabled the identification of a subgroup of patients with increased risk of renal injury over time. [ABSTRACT FROM AUTHOR]

Aim: The incidence of antenatal hydronephrosis (AHN) has also increased with the raised use of ultrasonography (US); however, there is no consensus on how to approach the babies who were diagnosed prenatally with AHN. The present study aims to investigate the postnatal examination, treatment, and results of babies diagnosed with AHN. Material and Methods: In this study, 276 infants who were followed-up with the diagnosis of AHN between January 2012 and December 2015 in the pediatric nephrology outpatient clinic were evaluated retrospectively. Two hundred and fifty babies with AHN (196 males and 54 females) included in our study. Babies with and without abnormality were compared and etiological causes and treatment modalities of babies with AHN were investigated in the postnatal follow-up. Results: Despite no abnormality detected in 144 (57.6) AHN patients, 106 babies (42.4%) had urinary system abnormality in the postnatal US. As the underlying anomalies, ureteropelvic junction obstruction (UPJO) was the most common in 67 kidneys (63.2%); vesicoureteral reflux (VUR) was found in 29 kidneys (%27.3), ureterovesical junction obstruction (UVJO) in 5 kidneys (4.7%) and posterior urethral valve (PUV) in 3 kidneys (2.8%). Conclusion: Evaluation of babies with AHN starting from postnatal first week will provide early diagnosis of urinary system pathologies and early treatment of babies diagnosed with obstructive pathology. [ABSTRACT FROM AUTHOR]

Paediatric urology is a subject that covers the urological aspects of care in children, some of which are seen also in adults, but may have specific diagnostic methods and treatments that are quite different. Additionally, it covers a range of congenital anomalies either on their own or in combination with a spectrum of disorders that need more complex management available at only specialized centres. For the purposes of a broad and basic understanding of the subject, this article will cover relevant topics and up-to-date guidelines. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the significance of renal pelvis aspiration (RPA) in the management of antenatal hydronephrosis (AHN). This study enrolled 15 AHN cases (one twin pregnancy) that necessitated RPA for AHN. Chromosomal abnormalities, gene disorders, and additional life‐threatening congenital abnormalities were eliminated prior to intrauterine interventions. Urine analysis were performed for the evaluation of renal function. Normal renal function was observed in six neonates/infants (40%) (group 1), whereas impaired renal function and various type of urinary system anomalies were observed in 9 neonates/infants (60%) (group 2) during the short‐term and longitudinal follow‐up periods. There were statistically significant differences in the oligohydroamniosis rate, mean fetal urine sodium value, mean fetal urine β2‐microglobulin, mean gestational week at birth, and mean birthweight values between the groups (P = 0.007, P < 0.001, P = 0.035, P < 0.001, and P = 0.001, respectively). Renal pelvis aspiration and urine analysis were substantial for the management of AHN in necessary cases. β2‐microglobulin and sodium are clinically useful markers to detect the presence of severe renal damage due to obstructive uropathy and thus, important adjuvants in the proper selection of fetuses for further antenatal interventions. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR), the retrograde flow of urine from the bladder toward the kidney, is congenital and often familial. VUR is common in childhood, but its precise prevalence is uncertain. It is about 10–20% in children with antenatal hydronephrosis, 30% in siblings of patient with VUR and 30–40% in children with a proved urinary tract infection (UTI). Ultrasonography is a useful initial revision but diagnosis of VUR requires a voiding cystourethrography (VCUG) or radionuclide cystogram (DRNC) and echo-enhanced voiding urosonography (VUS). Although for most, VUR will resolve spontaneously, the management of children with VUR remains controversial. We summarized the literature and paid attention to the studies whose quality is not adequate in the field of VUR management of children.

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.

Antenatal hydronephrosis is defined as dilatation of the renal pelvis with or without dilatation of calyces in the developing fetus. Although second trimester scan is more sensitive in detecting congenital abnormalities of kidney and urinary tract (CAKUT), it has been suggested that the third trimester scan is more predictive of postnatal outcome. This study aims to determine the incidence of antenatal hydronephrosis at our institution and the significance of third trimester scan in detecting CAKUT postnatally. It is a prospective observational study. During the 3-year study period from June 2013 to May 2016, all cases of antenatal hydronephrosis, defined as renal pelvic diameter (RPD) ≥4 mm in the second trimester and ≥7 mm in the third trimester scan, diagnosed in the fetal medicine unit of our hospital, were included and were followed up postnatally for 6 months. In the fetal medicine unit, 32,443 women were screened for anomalies, and hydronephrosis was detected in 269 cases. Incidence of antenatal hydronephrosis was observed to be 0.83% in our institution. In second trimester scan, of 80 cases with the left hydronephrosis, only 22 (27.5%) had postnatal CAKUT and of 70 cases with the right hydronephrosis, 18 (25.7%) had CAKUT. In the third trimester scan, it was observed that with RPD >10 mm, on the left side hydronephrosis, 87% had CAKUT on postnatal scan, and 85% with the right hydronephrosis had CAKUT. Sixty percent cases of hydronephrosis detected in the second trimester scan resolve in utero. In the third trimester scan with RPD <10 mm, the possibility of postnatal CAKUT is 23%, whereas if RPD is > 10 mm, then the possibility of postnatal CAKUT is 86%. Table 1 Incidence of hydronephrosis in <20 weeks and >32 weeks scan as per the renal pelvic diameter Renal pelvic diameter (mm) Timing (<20 weeks) Timing (>32 weeks) Incidence of CAKUT in Postnatal scans Left Right Left Right Left Right 4–7 56 51 12 8 nil 1 (12.5%) 7–10 21 18 55 64 15 (27%) 16 (25%) >10 3 1 69 46 60 (87%) 39 (85%) Total 80 70 136 118 75 (55%) 56 (47%) Flowchart 1- selection criteria (based on RPD) and number of cases recruited. RPD, renal pelvic diameter. [ABSTRACT FROM AUTHOR]

Data regarding spontaneous resolution of mild hydronephrosis consist of different etiologies, and hence, it is heterogeneous. The aim of this study is to evaluate spontaneous resolution rates and the time to complete resolution of antenatally detected isolated hydronephrosis in patients with renal pelvis antero-posterior diameter (RPAPD) ≤ 20 mm. Retrospective chart review of patients who were admitted to our pediatric nephrology clinic for the evaluation of antenatal hydronephrosis between 2011 and 2017 was conducted. Patients that had hydronephrosis with RPAPD ≤ 20 mm, < SFU (Society for Fetal Urology) grade IV on initial postnatal evaluation, and ≥ 3 months of follow-up with at least two renal ultrasounds (US) were included. Complete resolution of hydronephrosis was regarded as SFU grade 0 with a RPAPD of < 7 mm. Patients with ureteric and lower urinary tract abnormalities were excluded. There were a total of 276 patients who met the inclusion criteria. Median follow-up was 16 months (range 3-96 months). Hydronephrosis completely resolved in 198 patients (71.7%). Surgery was not required in any of the patients; however, nine patients (3.3%) showed progression to higher grades of hydronephrosis or increase in AP diameter. Median time to complete resolution of hydronephrosis was 6 months (range 2-35 months) in our study. Those with AP diameter < 10 mm became normal in median of 5 months, while it took median 11 months for patients with AP diameter 10-20 mm to become normalized (p < 0.001).Conclusion: Isolated antenatal hydronephrosis with RPAPD ≤ 20 mm would spontaneously resolve in 71.7% of the cases. Resolution may be expected to happen in 3 years, while the majority will take place in the first year of life. What is Known: • Antenatal hydronephrosis comprises an important amount of clinical visits. • Spontaneous resolution rates differ for various etiologies. What is New: • Isolated antenatal hydronephrosis with RPAPD ≤ 20 mm completely resolves within 3 years in approximately 72% of the cases. • Resolution can be observed within the first year of life in most of the cases. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Grading of hydronephrosis severity on postnatal renal ultrasound guides management decisions in antenatal hydronephrosis (ANH). Multiple systems exist to help standardize hydronephrosis grading, yet poor inter-observer reliability persists. Machine learning methods may provide tools to improve the efficiency and accuracy of hydronephrosis grading. To develop an automated convolutional neural network (CNN) model to classify hydronephrosis on renal ultrasound imaging according to the Society of Fetal Urology (SFU) system as potential clinical adjunct. A cross-sectional, single-institution cohort of postnatal renal ultrasounds with radiologist SFU grading from pediatric patients with and without hydronephrosis of stable severity was obtained. Imaging labels were used to automatedly select sagittal and transverse grey-scale renal images from all available studies from each patient. A VGG16 pre-trained ImageNet CNN model analyzed these preprocessed images. Three-fold stratified cross-validation was used to build and evaluate the model that was used to classify renal ultrasounds on a per patient basis into five classes based on the SFU system (normal, SFU I, SFU II, SFU III, or SFU IV). These predictions were compared to radiologist grading. Confusion matrices evaluated model performance. Gradient class activation mapping demonstrated imaging features driving model predictions. We identified 710 patients with 4659 postnatal renal ultrasound series. Per radiologist grading, 183 were normal, 157 were SFU I, 132 were SFU II, 100 were SFU III, and 138 were SFU IV. The machine learning model predicted hydronephrosis grade with 82.0% (95% CI: 75–83%) overall accuracy and classified 97.6% (95% CI: 95–98%) of the patients correctly or within one grade of the radiologist grade. The model classified 92.3% (95% CI: 86–95%) normal, 73.2% (95% CI: 69–76%) SFU I, 73.5% (95% CI: 67–75%) SFU II, 79.0% (95% CI: 73–82%) SFU III, and 88.4% (95% CI: 85–92%) SFU IV patients accurately. Gradient class activation mapping demonstrated that the ultrasound appearance of the renal collecting system drove the model's predictions. The CNN-based model classified hydronephrosis on renal ultrasounds automatically and accurately based on the expected imaging features in the SFU system. Compared to prior studies, the model functioned more automatically with greater accuracy. Limitations include the retrospective, relatively small cohort, and averaging across multiple imaging studies per patient. An automated CNN-based system classified hydronephrosis on renal ultrasounds according to the SFU system with promising accuracy based on appropriate imaging features. These findings suggest a possible adjunctive role for machine learning systems in the grading of ANH. Summary Table Confusion matrix for machine learning model hydronephrosis grading compared to radiologist interpretation according to the SFU system using 5 classes (normal, SFU I, SFU II, SFU III, and SFU IV). The columns are the radiologist grade for each patient (n = 710). The rows detail the convolutional neural network machine learning model classification for each patient. Dark grey shaded boxes indicate cases of the machine learning model classification matching the radiologist classification and light grey shaded boxes indicate the machine learning model prediction within one grade of the radiologist classification. Summary Table Radiologist SFU Classification Normal SFU I SFU II SFU III SFU IV Machine Learning Model SFU Classification Normal 169 (23.8%) 9 (1.3%) 4 (0.6%) 0 (0%) 0 (0%) SFU I 9 (1.3%) 115 (16.2%) 22 (3.1%) 0 (0.1%) 0 (0%) SFU II 5 (0.7%) 26 (3.7%) 97 (13.7%) 18 (2.5%) 0 (0%) SFU III 0 (0%) 6 (0.8%) 8 (1.1%) 79 (11.1%) 16 (2.3%) SFU IV 0 (0%) 1 (0.1%) 1 (0.1%) 3 (0.4%) 122 (17.2%) [ABSTRACT FROM AUTHOR]

Antenatal hydronephrosis (ANH) is one of the most common anomalies identified on prenatal ultrasound, found in up to 4.5% of all pregnancies. Children with ANH are surveilled with repeated renal ultrasound and when there is high suspicion for a ureteropelvic junction obstruction on renal ultrasound, a mercaptuacetyltriglycerine (MAG3) Lasix renal scan is performed to evaluate for obstruction. However, the challenging interpretation of MAG3 renal scans places patients at risk of misdiagnosis. Our objective was to analyze MAG3 renal scans using machine learning to predict renal complications. We hypothesized that our deep learning model would extract features from MAG3 renal scans that can predict renal complications in children with ANH. We performed a case-control study of MAG3 studies drawn from a population of children with ANH concerning for ureteropelvic junction obstruction evaluated at our institution from January 2009 until June of 2021. The outcome was renal complications that occur ≥6 months after an equivocal MAG-3 renal scan. We created two machine learning models: a deep learning model using the radiotracer concentration versus time data from the kidney of interest and a random forest model created using clinical data. The performance of the models was assessed using measures of diagnostic accuracy. We identified 152 eligible patients with available images of which 62 were cases and 90 were controls. The deep learning model predicted future renal complications with an overall accuracy of 73% (95% confidence inteveral [CI] 68–76%) and an AUC of 0.78 (95% CI 0.7, 0.84). The random forest model had an accuracy of 62% (95% CI 60–66%) and an AUC of 0.67 (95% CI. 0 64, 0.72) Our deep learning model predicted patients at high risk of developing renal complications following an equivocal renal scan and discriminate those at low risk with moderately high accuracy (73%). The deep learning model outperformed the clinical model built from clinical features classically used by urologists for surgical decision making. Our models have the potential to influence clinical decision making by providing supplemental analytical data from MAG3 scans that would not otherwise be available to urologists. Future multi-institutional retrospective and prospective trials are needed to validate our model. [Display omitted] [ABSTRACT FROM AUTHOR]

Background & Aim: Prediction of time to reflux can aid healthcare providers and preparation programs. We constructed a risk prediction instrument for occurrence reflux in children with antenatal hydronephrosis. Methods & Materials: Demographic and clinical information was collected retrospectively in children with the antenatal hydronephrosis and mostly with reflux, followed at least 5 years. Results: Accelerated failure time model of data from 333 children was developed to assess the risk of time to reflux. Likelihood ratio tests of statistical significant were used to identify best fitting predictive function. Variables “gender”, “Sr”, and “severity of ANH (in severe level)” were highly significant (p

Background: The aim of this study was comparison characteristics of family and demographics of children with antenatal hydronephrosis, in 2nd and 3rd trimester of pregnancy, in order to the need for postnatal management. Methods: This cross-sectional study described some information from family of children with antenatal hydronephrosis, at the Pediatric Urology Research Center of Children’s Hospital Medical Center of Tehran University of Medical Sciences. Data for 193 children, admitted in 2012-2013, were collected retrospectively. They were allocated to two groups of 2nd and 3rd trimester, based on the time of diagnosis antenatal hydronephrosis. Data analysis was done using SPSS. Chi-Square, Fisher-exact and independent t-test also Mantel-Hanzel test were used. P-value

Background: Antenatal hydronephrosis (AH) is found in 0.5-2% of neonates. The aim of the study was to assess the frequency of nephrolithiasis in infants with antenatal hydronephrosis and the risk factors of stone development. Methods: In this study, neonates with a history of prenatal hydronephrosis were enrolled during March 2002 until March 2012. Those with any evidence of urinary tract stone were assessed for infectious and metabolic risk factors of stone formation. Findings: From 285 studied neonates, 52 (18%) had nephrolithiasis on ultrasound studies and were enrolled into the study. The male to female ratio was 40 to 12. The stone diameter was 3-9 mm; only 1 patiens had bladder stone and all other stones were located in kidneys, more in left kidney. The stone was observed in 10% of patients with vesicoureteral reflux (VUR) and in 20-25% of infants with obstructive urinary disorders. Hypercalciuria was the most common metabolic abnormality. 6 patients (15%) had urinary tract infection (UTI) before detection of stone and 5 (13%) had UTI after diagnosis of nephrolithiasis. The frequency of UTI in patients with VUR and ureteropelvic junction obstruction was 29% and 13%, respectively. There was no history of UTI in patients with posterior urethral valve (PUV) before diagnosis of nephrolithiasis. There were no infectious or metabolic risk factors in 23 patients (58%). Conclusions: Urolithiasis in a common and important complication in infants with prenatal history of hydronephrosis. 64% of the patients had no risk factor other than hydronephrosis for stone formation.

Objective: This study aims to explore a new parameter, the calyceal-to-parenchymal ratio (CPR) of postnatal renal ultrasonography (RUS) as a predictor of surgery in newborns with possible ureteropelvic junction obstruction (UPJO). Although UPJO remains the main surgical category of antenatally detected hydronephrosis, there is a lack of a gold-standard test that predicts the need for pyeloplasty., Subjects and Methods: We retrospectively reviewed infants with a positive antenatal history of hydronephrosis who were confirmed to have grade 3 or 4 hydronephrosis on postnatal RUS between 2010 and 2020. We compared postnatal CPR between surgical and control groups and tested the correlation between postnatal CPR and diuretic renogram., Results: A total of 79 and 136 kidneys were included in the surgical and control groups, respectively. Kidneys that were managed with pyeloplasty between January 2010 and July 2020 were included in the surgical group, while kidneys from patients with comparable traits who were managed conservatively comprised the control group. At a mean age of 18.9 weeks at presentation and a mean follow-up period of 48.99 months, the median postnatal CPR was significantly greater in the surgical group (3.62 vs. 0.98, p<0.001). A postnatal CPR of 1.68 had a sensitivity and specificity of 96.2% and 84.8%, respectively, in predicting the need for future pyeloplasty (area under the curve (AUC)=0.966). There was a positive and significant correlation between postnatal CPR and the half-life of the renogram (p=0.018) but not significant with the differential function (p=0.090)., Conclusion: Diuretic renography has little capability for predicting future pyeloplasty. Current RUS grading systems do not offer an objective measure of renal parenchyma. Numerous other RUS parameters are less frequently utilized in clinical practice, and many are challenging to assess and require sophisticated software or equipment. Postnatal CPR is a promising tool for predicting the need for pyeloplasty in newborns with UPJO. Further prospective studies are needed to standardize and assess the reproducibility of this parameter., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Almodhen et al.)

To assess the outcome of successful pyeloplasty in infants with Ureteropelvic Junction Obstruction (UPJO) and a differential renal function of (DRF) < 35% whether they can attain normal postoperative renal function or not. All children who were diagnosed with antenatal hydronephrosis due to UPJO were presented to our institutions and were prospectively followed up. Pyeloplasty was performed based on predefined indications such as: initial DRF ≤40%, progression of hydronephrosis, and febrile urinary tract infection (UTI). A total of 173 children, who had successful surgical intervention due to impaired DFR, were divided according to their pre-intervention DRF value as follows: DRF <35% (group I) and DRF 35–40% (group II). The renal morphology and function changes were recorded and used for comparison between both groups. Group I was comprised of 79 patients, and group II included 94 patients. Pyeloplasty achieved significant improvement in the anatomical and functional indices in both groups (p-value <0.001). The degree of improvement in Anteroposterior diameter (APD) and cortical thickness was comparable in both groups (P-value, 0.64 and 0.44 respectively). While the improvement in the DRF was significantly higher in group I (16.06 ± 6.6) than in group II (6.25 ± 2.66) (P-value <0.001). Despite that, a significantly higher percentage of infants in group II (61.7%) achieved normal final DRF compared with only (10.1%) in group I (Figure). Even in severely impaired renal function (<35%), successful pyeloplasty can recover a significant part of lost renal function. However, most of these patients do not achieve normal postoperative renal function. [Display omitted] [ABSTRACT FROM AUTHOR]

Background & Aim: We aimed to describe a standard survival analysis, so that we can analyze some factors related to the time of occurrence of different types of reflux (unilateral-left, unilateralright, and bilateral) in children with antenatal hydronephrosis (ANH) and to provide an approach taking competing risks into account. Methods & Materials: We used data of 193 children that was collected from Pediatric Urology Research Center of Children’s Hospital Medical Center, affiliated to Tehran University of Medical Sciences, Iran. The cause-specific and subdistribution hazard were computed. P < 0.05 was considered as statistically significant. R packages were used for analyzing the data. Results: Among these infants (36 girls, 157 boys), 117 (68%) cases had bilateral reflux as the event of interest. The variables “Sex” and “Direction of ANH (in bilateral level)” were significantly different (P