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CHILDREN WITH MODERATE PRENATAL HYDRONEPHROSIS REQUIRE CLOSE POSTNATAL FOLLOW-UP
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CHILDREN WITH MODERATE PRENATAL HYDRONEPHROSIS REQUIRE CLOSE POSTNATAL FOLLOW-UP
Patricio C. Gargollo, MD, Drew A. Freilich, MD, Carlo C. Passerotti, MD, Andres Silva, MD, Alan B. Retik, MD, Hiep T. Nguyen, MD.
Children's Hospital Boston, Boston, MA, USA.
Background
It is difficult to predict which patients with prenatally diagnosed hydronephrosis (PNH) will require eventual surgical intervention or will suffer significant morbidity related to their condition. Some studies suggest that these children do not need longitudinal follow-up. We examine the long term clinical and surgical outcomes in a large cohort of patients with moderate hydronephrosis diagnosed prenatally.
Methods
Since 1998 all patients referred to our institution with a diagnosis of PNH have been followed prospectively. Results from postnatal radiographic studies including renal ultrasound (RUS), renal scans (DMSA, MAG-3), and voiding cystourethrograms as well as any surgical interventions were recorded. Only patients with post-natal moderate hydronephrosis (PNMH) defined as Society of Fetal Urology (SFU) grade 2-3 were included for this analysis. A Cox proportional hazards model was used to identify variables associated with need for surgical intervention and hydronephrosis resolution.
Results Out of 1441 patients with PNH, 496 (34.4 %) had PNMH. Mean length patient follow up was 9.2 years (+/- 3.3). When evaluating all diagnoses, 139 patients (28%) underwent a total of 144 surgical procedures (Table 1). Mean age at first surgery for all diagnoses was 1.4 yrs (+/- 0.14). Table 2 shows the primary diagnoses as well as the percent requiring surgery according to diagnosis. Of 314 patients (63%) that were diagnosed with uretero-pelvic junction obstruction (UPJO), 203 (64%) had PNMH resolution at a mean of 3.2 years (+/- 2.4). Of the remaining 111 patients 56 (50%) required surgery at a mean age of 1.8 yrs and 55 (50 %) continue to be followed. Patients with PNMH that were on antibiotic prophylaxis had a significantly lower rate of UTI than those not taking antibiotics (p= 0.025)
Conclusions
Contrary to several previous studies our data suggests that a significant number of patients with PNMH will not have resolution of hydronephrosis and will require eventual surgical intervention. Therefore all patients with MH require close longitudinal follow-up.
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