ESPN 51th Annual Meeting

ESPN 2018


 
TIME TO RESOLUTION OF ANTENATALLY DETECTED HYDRONEPHROSIS WITH ANTEROPOSTERIOR DIAMETER ≤20MM
AHMET MIDHAT ELMACI 1 MUHAMMET İRFAN DÖNMEZ 2

1- KONYA DR.ALI KEMAL BELVIRANLI WOMENS MATERNITY AND CHILDRENS HOSPITAL
2- KONYA TRAINING AND RESEARCH HOSPITAL
 
Introduction:

Evaluation of antenatal hydronephrosis comprises an important number of clinical visits. Even though hydronephrosis is transient in 50-88% of these cases, there is still debate on the follow-up schedule. The aim of this study is to evaluate how long would it take for the resolution of prenatally detected hydronephrosis with anteroposterior (AP) diameter ≤20mm.

Material and methods:

Retrospective chart review of patients who were admitted to our pediatric nephrology clinic for the evaluation of antenatal hydronephrosis between 2008 and 2017 was conducted. Hydronephrosis was graded as per Society for Fetal Urology (SFU) grading system, additionally using AP diameter measurements. Complete resolution of hydronephrosis was regarded as SFU grade 0 with an AP diameter of <7mm. Patients that had hydronephrosis with AP diameter ≤20mm, <SFU grade 4 on initial postnatal evaluation and >3 months of follow-up with at least 2 ultrasounds were included. Patients with ureteric dilatation, anatomic abnormalities (ureterocele, duplex kidney etc.), neurogenic bladder, posterior urethral valves and those who were diagnosed with vesicoureteric reflux during follow-up were excluded. Gender and laterality were noted.

Results:

There was a total of 276 patients who met the inclusion criteria. There were 39 right sided, 201 left sided and 36 bilateral cases. Within the cohort, 137 patients had AP diameter <10mm and 139 had AP diameter 10-20mm during the initial urinary ultrasonography (US). Sixty-one of them were females and 215 of them were male. Mean age at the time of first US was 33.8±27.7 days. Mean follow-up was 21.3 months (range 3-96 months). Complete remission of hydronephrosis during the follow-up period was found in 198 patients (71.7%). Surgery was not required in any of the patients however 9 patients (3.3%) showed progression to higher grades of hydronephrosis or increase in AP diameter. Mean time to complete resolution of hydronephrosis was 8.7 months (range 2-35 months) in our study. Those with AP diameter <10mm returned to normal in 6.5±5.3 months while it took 12.7±8.1 months for patients with AP diameter 10-20mm to become normalized (p<0.001). There was no significant difference in terms of gender and laterality (p>0.05, for both).

Conclusions:

In patients with antenatally detected hydronephrosis with AP diameter ≤20mm, complete resolution can be expected within two years in nearly 3/4 of the cases. Therefore, follow-up protocols and consulting of families should be accordingly.