Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and Radiologists

Zanetta, Vitor C.; Rosman, Brian M.; Bromley, B; Shipp, Thomas; Chow, Jeanne S.; Campbell, Jeffrey B.; Herndon, C.D. Anthony; Passerotti, Carlo C.; Cendron, Marc; Retik, Alan B.; Nguyen, Hiep T.

doi:10.1016/j.juro.2012.07.011

Cited by 51 publications

(38 citation statements)

References 27 publications

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“…In the setting of evaluation for VUR, the AUA guidelines on VUR state that for prenatally identified SFU 1 or 2, screening voiding cystour-ethrogram is optional [7]. Despite these publications management strategies such as surveillance and antibiotic prophylaxis for UTI prevention continue to vary [8]. …”

Section: Introductionmentioning

confidence: 99%

“…The heterogeneity of diagnosis criteria coupled with variation in surveillance methods has interfered with the development of standard guidelines [8]. In order to more clearly understand the natural history of low-grade hydro-nephrosis, we used strict criteria to review our experience with isolated low-grade hydronephrosis and determined the resolution rate of hydronephrosis within a year of diagnosis and at last ultrasound imaging, surgical intervention rate and UTI rate.…”

Section: Introductionmentioning

confidence: 99%

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Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Madden‐Fuentes¹,

McNamara²,

Nseyo³

et al. 2014

Journal of Pediatric Urology

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Objective Diagnosis of low-grade hydronephrosis often occurs prenatally, during evaluation after urinary tract infection (UTI), or imaging for non-urologic reasons within the first year of life. Its significance in terms of resolution, need for antibiotic prophylaxis, or progression to surgery remains uncertain. We hypothesized that isolated low-grade hydronephrosis in this population frequently resolves, UTIs are infrequent, and progression to surgical intervention is minimal. Patients and methods Children <12 months old diagnosed hydronephrosis (Society for Fetal Urology [SFU] grade 1 or 2) between January 2004 and December 2009 were identified by ICD9 code. Patients with other urological abnormalities were excluded. Stability of hydronephrosis, UTI (≥100,000 CFU/mL bacterial growth) or need for surgical intervention was noted. Results Of 1496 infants with hydronephrosis, 416 (623 renal units) met inclusion criteria. Of 398 renal units with grade 1 hydronephrosis, 385 (96.7%) resolved or remained stable. Only 13 (3.3%) worsened, of which one underwent ureteroneocystostomy. Of 225 renal units with grade 2 hydro-nephrosis, 222 (98.7%) resolved, improved or remained stable, three (1.3%) worsened, of which one required pyeloplasty. Only 0.7% of patients in the ambulatory setting had a febrile UTI. Conclusions Low-grade hydronephrosis diagnosed within the first year of life remains stable or improves in 97.4% of renal units. Given the low rate of recurrent UTI in the ambulatory setting, antibiotic prophylaxis has a limited role in management.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Madden‐Fuentes¹,

McNamara²,

Nseyo³

et al. 2014

Journal of Pediatric Urology

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“…Thus, it may convey a more comprehensive picture of risk. Urinary tract dilatation also incorporates more information than the APD system commonly used in obstetric practice . Agreement on several of the individual UTD components was substantial, including APD measurement and the assessment of ureteral dilatation.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Reliability of the Antenatal Consensus Classification System for Urinary Tract Dilatation

Nelson

Heller

Benson

et al. 2019

J of Ultrasound Medicine

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Objectives The consensus classification system for urinary tract dilatation (UTD) was designed to be more objective and reproducible than previously used systems. We sought to evaluate interobserver reliability of UTD components and overall scores in a prenatal population undergoing third‐trimester ultrasound examinations. Methods We retrospectively identified patients who underwent antenatal ultrasound examinations for UTD between 28 and 40 weeks’ gestation. All images from individual studies of 300 fetuses were reviewed independently by 5 experienced sonologists (1 maternal‐fetal medicine specialist and 4 radiologists). Urinary tract dilatation scores (normal, A1, or A2/3) and Society for Fetal Urology (SFU) scores were assigned. Interobserver agreement between raters was evaluated with the Fleiss κ statistic. Results Overall interobserver agreement for the antenatal UTD risk score showed substantial agreement among all 5 readers (κ = 0.657 [95% confidence interval, 0.632, 0.683]; P < .001). All 5 readers applied the same UTD risk score in 53.7% of cases. Some variability in the antenatal UTD score and individual elements was observed. At least 2 UTD risk scores were assigned to a specific individual patient in 46.3% of cases (139 of 300), and all 3 UTD risk scores were assigned to a specific individual patient in 1.7% of cases (5 of 300). In 18.0% of cases (54 of 300), at least 2 readers assigned a UTD score different from that assigned by the other readers. Agreement was lowest for parenchymal appearance (κ = 0.225). Agreement for the SFU system was fair (κ = 0.368; P < .001). Conclusions Interobserver agreement for the antenatal UTD grading system was substantial. Compared to the SFU system, the antenatal UTD system showed better agreement among readers.

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“…Zanetta et al (page 1935) from several institutions electronically surveyed "experts" in maternal fetal medicine, pediatric urology and pediatric radiology about their recommendations for the management of mild prenatal hydronephrosis. 7 Overall, approximately 50% of the subspecialists responded to the survey.…”

Section: Variations In the Management Of Mild Prenatal Hydronephrosismentioning

confidence: 99%

This Month in Pediatric Urology

Baskin¹

2012

Journal of Urology

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Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and Radiologists

Cited by 51 publications

References 27 publications

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Interobserver Reliability of the Antenatal Consensus Classification System for Urinary Tract Dilatation

This Month in Pediatric Urology

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