10 Years of Antenatal Hydronephrosis Experience Comparing Two Different Guidelines

Abstract

Background: With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. It is important to distinguish infants with significant illness that require long-term follow-up or surgery, from those with transient hydronephrosis and minimum need for invasive investigations. Methods: We aimed to compare the results prepared by the CAKUT Working Group of the Turkish Society of Pediatric Nephrology (TSPN) in the 2015 TSPN CAKUT Guideline with the Tepecik AH Guideline results that were previously utilized in our hospital. The patients were examined in two groups, as Group 1 (Tepecik AH Guideline) and Group 2 (TSPN CAKUT Guideline). Additional imaging needs and numbers, radiation exposures, and surgical requirement rates were compared between the groups. Results: The VUR detection rate (38.5%) for voiding cystourethrogram (VCUG), which was less in the patients in Group 2, was significantly higher than in the patients in Group 1 (13.4%) (p=0.0002). It was found the patients who were determined to be abnormal with dimercaptosuccinic acid (DTPA) were similar in Group 1 (28.5%) and Group 2 (26.4%) (p=0.11). More obstruction was diagnosed in the patients in Group 2 (68.8%) with DTPA than in Group 1 (29.4%) (p=0.0001). The median radiation exposure (500 mrem) in Group 1 was significantly higher than in Group 2 (200 mrem) (p<0.001). It was found that significantly fewer patients were operated on in Group 2 (21.9%) than in Group 1 (34.2%) (p=0.005). Conclusions: The TSPN CAKUT Guideline appears to be a less invasive, simpler, low-radiation exposure guide.