| 1. Longpre M, Nguan A, Macneily AE, Afshar K. Prediction of the outcome of antenatally diagnosed hydronephrosis: a multivariable analysis. J Pediatr Urol. 2012;8(2):135-139. |
Observational-Dx |
100 children; 80 males, 20 females |
To determine independent predictors for resolution of antenatal hydronephrosis (ANH) using a multivariable analysis model. |
Median follow up was 34 months (range 3-204). Hydronephrosis in 62 units resolved spontaneously and pyeloplasty was done in 29. The remaining 27 units had persistent uncomplicated hydronephrosis at last follow up. Multivariate analysis showed larger antero-posterior pelvic diameter (APD) (hazard ratio 0.54; 95%CI 0.36-0.80) and Society for Fetal Urology (SFU) grade 4 (HR 0.34; 95%CI 0.13-0.90) to be associated with a significantly lower likelihood of resolution. The mean initial APD in resolved cases was 9.4mm as opposed to 29.0mm in cases requiring surgery. |
3 |
| 2. Mallik M, Watson AR. Antenatally detected urinary tract abnormalities: more detection but less action. Pediatr Nephrol. 2008;23(6):897-904. |
Observational-Dx |
350 infants |
To present the findings of a prospective cohort study of babies born with antenatally detected urinary tract abnormalities (AUTAs) between 1999-2003 and compare the outcomes with those of an earlier cohort born between 1989 and 1993. |
Of the 350 infants on which we had data, 48.6% (170/350) were in the non-specific dilatation (NSD) category, and vesicoureteric reflux (VUR) was detected in 12%. Restricting investigations to those who had an anteroposterior renal pelvic diameter (APRPD) > or =10 mm at >30 weeks of gestation could have reduced the number with NSD in the more recent cohort (26/115; 25%), but 25% of those with pelviureteric junction hold-up and 50% with VUR would have been missed. Significantly fewer patients in the more recent cohort underwent surgery (7 vs. 21%; p<0.001). There is a trend towards larger APRPD's on third trimester scans being associated with more significant pathology, but there is a lot of clinical overlap. |
3 |
| 3. Nguyen HT, Benson CB, Bromley B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982-998. |
Review/Other-Dx |
N/A |
To develop a unified classification system with an accepted standard terminology for the diagnosis and management of prenatal and postnatal Urinary tract (UT) dilation. |
The recommendations proposed in this consensus statement are based on a detailed analysis of the current literature and expert opinion representing common clinical practice. The proposed UTD Classification System (and hence the severity of the UT dilation) is based on six categories in US findings: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. The classification system is stratified based on gestational age and whether the UT dilation is detected prenatally or postnatally. The panel also proposed a follow-up scheme based on the UTD classification. |
4 |
| 4. Nguyen HT, Herndon CD, Cooper C, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6(3):212-231. |
Review/Other-Dx |
N/A |
To review the current literature on the diagnosis and management of antenatal hydronephrosis (ANH) and proposes a unified approach to the care of the fetus/child with ANH. |
No results stated in abstract. |
4 |
| 5. Matsui F, Shimada K, Matsumoto F, Takano S. Late recurrence of symptomatic hydronephrosis in patients with prenatally detected hydronephrosis and spontaneous improvement. J Urol. 2008;180(1):322-325; discussion 325. |
Review/Other-Dx |
344 children |
To carry out long-term follow up in children with prenatally diagnosed hydronephrosis in order to define the need for continuous observation after improvement of hydronephrosis. |
Of the 394 kidneys followed nonoperatively 4 (1%) displayed worsened hydronephrosis after spontaneous improvement. Initial grade of hydronephrosis was grade I in 1 patient, grade II in 1, grade III in 1 and grade IV in 1. On serial ultrasonographic followup hydronephrosis worsened to grade IV in 3 kidneys and to grade III in 1 kidney. Mean patient age at worsening of hydronephrosis was 40 months (range 22 to 60). All 4 patients presented with clinical symptoms. All patients who underwent pyeloplasty displayed no symptoms, and had improved hydronephrosis after pyeloplasty. |
4 |
| 6. Passerotti CC, Kalish LA, Chow J, et al. The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. J Pediatr Urol. 2011;7(2):128-136. |
Observational-Dx |
1441 children; 38 studies. |
To evaluate the effectiveness of the first postnatal ultrasound (US) in predicting the final postnatal diagnosis using a database of children followed prospectively for antenatal hydronephrosis, and to compare these findings with a systematic review of the literature. |
62.0% of renal units (RUs) had transient or non-obstructive hydronephrosis. Increasing degree of hydronephrosis correlated with increased risk of urological pathologies (from 29.6% RUs in the mild group to 96.3% RUs in the severe group). A systematic review of the literature indicated very poor quality data, but the findings appeared to be concordant with those from our patient population. |
3 |
| 7. Pates JA, Dashe JS. Prenatal diagnosis and management of hydronephrosis. Early Hum Dev. 2006;82(1):3-8. |
Review/Other-Dx |
N/A |
To describe the prenatal diagnosis, differential diagnosis, and management of hydronephrosis. |
No results stated in abstract. |
4 |
| 8. Signorelli M, Cerri V, Taddei F, Groli C, Bianchi UA. Prenatal diagnosis and management of mild fetal pyelectasis: implications for neonatal outcome and follow-up. Eur J Obstet Gynecol Reprod Biol. 2005;118(2):154-159. |
Observational-Dx |
375 fetuses |
To describe the natural history of pyelectasis from its detection in the second trimester to delivery, its capability to predict renal pathology and whether prenatal development of pelvic dilatation is correlated to its postnatal evolution. |
Two-hundred and eighty cases underwent at least two examinations before birth. 73.1% were male fetuses. 57.4% had a bilateral pyelectasis. Prenatal evolution of pelvic dilatation was the following:18.6% of the cases normalized, in 34.6% of the cases the dilatation reduced but did not disappear, in 30.7% it remained unchanged, while it worsened in 16.4%. One case from the first group, three cases from the second, seven cases from the third and 11 cases from the fourth needed surgical treatment. 1.9, 7.2, 18.6, 23.9% of cases respectively worsened after birth in the four groups (trend: P=0.001). |
3 |
| 9. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993;23(6):478-480. |
Review/Other-Dx |
N/A |
To illustrate the appearance of the calices, renal pelvis and renal parenchyma are key in determining the grade of hydronephrosis (HN). |
No results stated in abstract. |
4 |
| 10. Sidhu G, Beyene J, Rosenblum ND. Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis. Pediatr Nephrol. 2006;21(2):218-224. |
Meta-analysis |
25 studies |
To perform a systematic review and meta-analysis to determine the outcome of idiopathic antenatal hydronephrosis (IAHN). |
A systematic analysis of data extracted from 25 articles revealed overall resolution of pelviectasis in milder cases of isolated antenatal hydronephrosis (IAHN) (Society of Fetal Urology [SFU] grade 1-2; anterior posterior pelvic diameter [APPD]<12 mm). In contrast, IAHN of higher severity (grades 3-4; APPD>12 mm) resolved with a lower frequency. Meta-analysis of data extracted from seven papers showed stabilization of pelviectasis in 98% of patients with grades 1-2 (95% confidence interval [CI] 0.93-1.0; p =0.0008) and in 51% of patients with grades 3-4 (95% CI 0.34-0.68; p <0.00001). Grades 1-2 pelviectasis was five times more likely to stabilize than grades 3-4 pelviectasis (odds ratio [OR] 4.69; 95% CI 1.73-12.76; p =0.002). |
M |
| 11. Duin LK, Willekes C, Koster-Kamphuis L, Offermans J, Nijhuis JG. Fetal hydronephrosis: does adding an extra parameter improve detection of neonatal uropathies? J Matern Fetal Neonatal Med. 2012;25(7):920-923. |
Review/Other-Dx |
612 fetuses |
To assess the correlation of the average antero-posterior, transverse and longitudinal diameters of the fetal renal pelvis to neonatal outcome. |
Of all the fetuses diagnosed with renal pelvis dilatation in the third trimester of pregnancy, 73 (11.9%) infants needed postnatal surgery. The majority of the postnatal surgery was performed in the group of fetuses with severe hydronephrosis (8.2%). This resulted in a likelihood ratios (LR) of 5.81 and a post-test probability of 61.3%. In total, 78.8% of the fetuses with hydronephrosis had spontaneous resolution across all grades of severity on the first postnatal ultrasonogaphic investigation or during their follow-up. In 9.3% of the cases, uropathies were diagnosed, but no surgical intervention had taken place during the follow-up period. Using the Corteville criteria as gold standard for the third trimester (AP >/= 7 mm), 11 (1.8%) patients would not have been diagnosed with uropathies. And in the case of antero-posterior (AP) >/= 10 mm, 5.1% of the cases would have been missed. |
4 |
| 12. Riccabona M, Avni FE, Blickman JG, et al. Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol. 2008; 38(2):138-145. |
Review/Other-Dx |
N/A |
To present basic proposals for algorithms and procedures for imaging the pediatric genitourinary tract based on initial discussion at a paediatric uroradiology symposium and proposals of the European Society of Uroradiology (ESUR) Pediatric Uroradiologic Guidelines Subcommittee. |
The task began with reassessment of : 1) imaging in UTI in infants and children, 2) postnatal imaging in mild-to-moderate neonatal hydronephrosis, 3) how to perform VCUG, and 4) procedural recommendations for paediatric urosonography. This list is incomplete, and future recommendations will be developed, discussed and presented at forthcoming meetings. |
4 |
| 13. Chow JS, Darge K. Multidisciplinary consensus on the classification of antenatal and postnatal urinary tract dilation (UTD classification system). Pediatr Radiol. 2015;45(6):787-789. |
Review/Other-Dx |
N/A |
To describe the multidisciplinary consensus on the classification of antenatal and postnatal urinary tract dilation (UTD classification system) |
No abstract available. |
4 |
| 14. Swenson DW, Darge K, Ziniel SI, Chow JS. Characterizing upper urinary tract dilation on ultrasound: a survey of North American pediatric radiologists' practices. Pediatr Radiol. 2015;45(5):686-694. |
Review/Other-Dx |
N/A |
To establish how North American pediatric radiologists define and report findings of urinary tract dilation on ultrasound (US). |
Two hundred eighty-four pediatric radiologists answered the survey resulting in a response rate of 19.0%. There is a great variety in the terms used to describe urinary tract dilation with 66.2% using descriptive terminology, 35.6% using Society for Fetal Urology (SFU) grading system and 35.9% measuring anterior-posterior diameter (APD) of the renal pelvis. There is no consensus for a normal postnatal APD or the meaning of hydronephrosis. For the same images, descriptions vary widely in degree of severity ranging from normal to mild to severe. Similar variability exists among those using the SFU system. Ninety-seven percent say they believe a unified descriptive system would be helpful and 87.7% would use it if available. |
4 |
| 15. Keays MA, Guerra LA, Mihill J, et al. Reliability assessment of Society for Fetal Urology ultrasound grading system for hydronephrosis. J Urol. 2008;180(4 Suppl):1680-1682; discussion1682-1683. |
Observational-Dx |
50 patients |
To assess the intrarater and interrater reliability of the Society for Fetal Urology grading system for hydronephrosis and examine levels of agreement by the degree of hydronephrosis (grades 0 to 4) and level of experience (staff vs trainee). |
Staff and trainee raters independently assigned Society for Fetal Urology grades to 50 patients (99 renal units). The average number of images per ultrasound was 41, including the right and left kidneys. Overall interrater agreement for staff individuals was substantial for grade 0, moderate for grades 1, 2 and 4, and only slight to fair for grade 3. Intrarater agreement was substantial to almost perfect for staff agreement (range 69% to 94%, kappa 0.56 to 0.89) and trainees (range 63% to 90%, kappa 0.48 to 0.85). |
3 |
| 16. Kim SY, Kim MJ, Yoon CS, Lee MS, Han KH, Lee MJ. Comparison of the reliability of two hydronephrosis grading systems: the Society for Foetal Urology grading system vs. the Onen grading system. Clin Radiol. 2013;68(9):e484-490. |
Observational-Dx |
90 pediatric patients |
To compare the reliability of the conventional ultrasonography grading system for hydronephrosis as suggested by the Society for Fetal Urology (SFU) in 1993 and that developed by Onen in 2007. |
Intra-observer agreement was substantial to almost perfect in both the SFU (kappa 0.79-0.95) and the Onen (kappa 0.66-0.97) grading system without difference. The overall interobserver agreement was substantial in both the SFU (kappa 0.61-0.68) and the Onen (kappa 0.66-0.76) grading system. However, interobserver agreement was fair to moderate for SFU grades 1 and 2 and Onen grades 2 and 3. |
2 |
| 17. de Kort EH, Bambang Oetomo S, Zegers SH. The long-term outcome of antenatal hydronephrosis up to 15 millimetres justifies a noninvasive postnatal follow-up. Acta Paediatr. 2008;97(6):708-713. |
Observational-Dx |
125 infants |
To assess the incidence of urinary tract infections (UTIs) and surgery in infants with different grades of antenatal hydronephrosis (ANH) and to evaluate incidence, severity and course of underlying vesicoureteral reflux (VUR). |
UTIs developed in 4 of 106 infants from group I and 5 of 19 infants from group II. Surgical interventions were performed on 1 of 106 patients of group I and 7 of 19 patients of group II. These differences were statistically significant (p-values 0.004 and <0.001, respectively). In group I, 6 of 106 patients had VUR; none of them required surgical intervention and only two developed a UTI (one of whom also had contralateral ureteropelvic junction obstruction). Five of 19 infants in group II had underlying VUR, four of them with associated anomalies, 1 infant required surgical correction and 4 developed UTIs. |
3 |
| 18. Dias CS, Silva JM, Pereira AK, et al. Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol. 2013;190(2):661-666. |
Observational-Dx |
371 newborns |
To evaluate the diagnostic accuracy of renal pelvic dilatation for detecting infants with prenatal hydronephrosis who will need surgical intervention for ureteropelvic junction obstruction during followup. |
A total of 312 patients were included in the analysis and 25 (7.5%) infants underwent pyeloplasty. The diagnostic performance for detecting the need for pyeloplasty was excellent for all ultrasonography measurements. The AUC was 0.96 (95% CI 0.92-0.98) for fetal renal pelvic dilatation, 0.97 (95% CI 0.95-0.98) for postnatal renal pelvic dilatation and 0.95 (95% CI 0.92-0.97) for the Society for Fetal Urology grading system. A cutoff of 18 mm for fetal renal pelvic dilatation and a cutoff of 16 mm for postnatal renal pelvic dilatation had the best diagnostic odds ratio to identify infants who needed pyeloplasty. Considering a diagnosis to be positive only if fetal renal pelvic dilatation was greater than 18 mm and postnatal dilatation was greater than 16 mm, sensitivity was 100% and specificity was 86% (95% CI 80.7-89.9). |
3 |
| 19. Abdulaziz Kari J, Habiballah S, Alsaedi SA, et al. Incidence and outcomes of antenatally detected congenital hydronephrosis. Ann Saudi Med. 2013;33(3):260-264. |
Review/Other-Dx |
327 fetuses |
To determine the incidence and outcomes of antenatally diagnosed congenital hydronephrosis in a large cohort. |
Antenatally detected urinary tract abnormalities (ADUTA) were diagnosed in 327 fetuses (1.7%). The commonest pathology was congenital hydronephrosis (n=313, 95.7%). Cystic renal anomalies were reported in 4 babies (1.2%), and 10 children (3.1%) were reported to have other renal anomalies, including duplex kidneys or a single kidney. A total of 240 babies with congenital hydronephrosis were followed up. Hydronephrosis resolved in 99 children (41.2%) within 2 months of birth. A total of 29 subjects had underlying renal anomalies (12.1%), including vesicoureteral reflux (n=12, 5%), pelvi-ureteric junction obstruction (n=14, 5.8%), and posterior urethral valve (n=3, 1.3%). The best predictor for nonresolving congenital hydronephrosis and underlying anatomical abnormalities was the anteroposterior diameter on the first postnatal scan. A cut-off point of 5 mm was found to be 83% sensitive in predicting nonresolving hydronephrosis, while 7 mm was 88% sensitive and 10 mm was 94% sensitive. |
4 |
| 20. Belarmino JM, Kogan BA. Management of neonatal hydronephrosis. Early Hum Dev. 2006;82(1):9-14. |
Review/Other-Dx |
N/A |
To review the current literature on the management of neonatal hydronephrosis, establish clinical guidelines and discuss future research directions to help understand better the natural history of neonatal hydronephrosis. |
No results stated in abstract. |
4 |
| 21. Coelho GM, Bouzada MC, Pereira AK, et al. Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol. 2007;22(10):1727-1734. |
Observational-Dx |
192 infants |
To report the outcome of infants with antenatal hydronephrosis. |
Of 89 patients with mild dilatation, 16 (18%) presented uropathy. Median follow-up time was 24 months. Twenty-seven patients (15%) required surgical intervention. During follow-up, urinary tract infection (UTI) occurred in 27 (14%) children. Of 89 patients with mild dilatation, seven (7.8%) presented UTI during follow-up. Renal function, blood pressure, and somatic growth were within normal range at last visit. The majority of patients with mild fetal renal pelvic dilatation (RPD) have no significant findings during infancy. Nevertheless, our prospective study has shown that 18% of these patients presented uropathy and 7.8% had UTI during a medium-term follow-up time. |
2 |
| 22. Fefer S, Ellsworth P. Prenatal hydronephrosis. Pediatr Clin North Am. 2006;53(3):429-447, vii. |
Review/Other-Dx |
1 patient |
No abstract available. |
No abstract available. |
4 |
| 23. Gokaslan F, Yalcinkaya F, Fitoz S, Ozcakar ZB. Evaluation and outcome of antenatal hydronephrosis: a prospective study. Ren Fail. 2012;34(6):718-721. |
Observational-Dx |
136 infants |
To describe the clinical outcomes of infants with Antenatal hydronephrosis (AHN) and to contribute to the definition of the postnatal evaluation of these patients. |
The grade of hydronephrosis (HN) was found to be correlated with the increased risk of urologic pathologies. Frequency of vesicoureteral reflux was found to be significantly lower in patients with mild HN (6%) as compared to patients with severe AHN (29%) (p = 0.005). In addition, the risk of urinary tract infection increases with increasing grades of HN (10% vs. 29%, p = 0.006). The frequency of spontaneous resolution in patients with mild AHN (64%) was also significantly higher than in patients with severe HN (29%) (p < 0.001). |
2 |
| 24. Sharifian M, Esfandiar N, Mohkam M, Dalirani R, Baban Taher E, Akhlaghi A. Diagnostic accuracy of renal pelvic dilatation in determining outcome of congenital hydronephrosis. Iranian journal of Kidney Diseases. 8(1):26-30, 2014 Jan. |
Observational-Dx |
178 newborns |
To investigate the natural course of prenatal hydronephrosis and the accuracy of postnatal anterior-posterior pelvic diameter (APD) in determining the outcome. |
Of 178 neonates, 42 (23%) required surgery. The area under the curve for APD to predict the need for surgery was 0.925 with an APD cutoff of 15 mm. The diagnostic value of APD for determining the need for surgery was determined by sensitivity and specificity of 95.2% and 73.5%, respectively. |
2 |
| 25. Sinha A, Bagga A, Krishna A, et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr. 50(2):215-31, 2013 Feb. |
Review/Other-Dx |
N/A |
To update guidelines and recommendations published in 2000 pertaining to increased detection of anomalies of the kidneys and urinary tract through widespread antenatal screening. |
No results stated in abstract. |
4 |
| 26. Aksu N, Yavascan O, Kangin M, et al. Postnatal management of infants with antenatally detected hydronephrosis. Pediatr Nephrol. 2005;20(9):1253-1259. |
Observational-Dx |
156 neonates |
To demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. |
In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94+/-5.10 weeks. The mean duration of postnatal follow-up was 26.3+/-13.56 months (range 3-60 months). The mean APPD of the fetal renal pelvis was 10.35+/-3.24 mm (5-9 mm in 84 kidneys, 10-14 mm in 96 kidneys and > or =15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). I |
2 |
| 27. Kitchens DM, Herndon CD. Postnatal imaging of antenatal hydronephrosis. ScientificWorldJournal. 2009;9:393-399. |
Review/Other-Dx |
N/A |
To discuss an overview of renal ultrasound, voiding cystourethrography, renal scintigraphy, and magnetic resonance urography in the setting of antenatal hydronephrosis |
No results stated in abstract. |
4 |
| 28. Riccabona M. Assessment and management of newborn hydronephrosis. World J Urol. 2004;22(2):73-78. |
Review/Other-Dx |
N/A |
To present imaging recommendations in pediatric uroradiology. |
No results stated in abstract. |
4 |
| 29. Yamacake KG, Nguyen HT. Current management of antenatal hydronephrosis. [Review]. Pediatr Nephrol. 28(2):237-43, 2013 Feb. |
Review/Other-Dx |
N/A |
To evaluate our current understanding of prenatal detection and postnatal evaluation of ANH, as well as the wide spectrum of possible interventions. |
No results stated in abstract. |
4 |
| 30. Becker AM. Postnatal evaluation of infants with an abnormal antenatal renal sonogram. Curr Opin Pediatr. 2009;21(2):207-213. |
Review/Other-Dx |
N/A |
To review the most commonly detected antenatal renal abnormalities and the current recommendations for postnatal evaluation. |
There is a low rate of detectable renal abnormalities in infants with a normal postnatal sonogram at 4–6 weeks of age. Routine prophylactic antibiotics are not indicated in infants with isolated antenatal hydronephrosis. Infants with a multicystic dysplastic kidney and a normal contralateral kidney on renal ultrasound do not require further evaluation. Parents of these children should be counseled on symptoms of urinary tract infections to allow prompt diagnosis. |
4 |
| 31. Skoog SJ, Peters CA, Arant BS, Jr., et al. Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report: Clinical Practice Guidelines for Screening Siblings of Children With Vesicoureteral Reflux and Neonates/Infants With Prenatal Hydronephrosis. J Urol. 2010;184(3):1145-1151. |
Review/Other-Dx |
N/A |
To summarize the existing evidence pertaining to screening of siblings and offspring of index patients with vesicoureteral reflux and infants with prenatal hydronephrosis and to develop clinical practice guidelines based on this evidence to manage the clinical scenarios insofar as the data permit. |
In screened populations the prevalence of vesicoureteral reflux is 27.4% in siblings and 35.7% in offspring. Prevalence decreases at a rate of 1 screened person every 3 months of age. The prevalence is the same in males and females. Bilateral reflux prevalence is similar to unilateral reflux. Grade I-II reflux is estimated to be present in 16.7% and grade III-V reflux in 9.8% of screened patients. The estimate for renal cortical abnormalities overall is 19.3%, with 27.8% having renal damage in cohorts of symptomatic and asymptomatic children combined. In asymptomatic siblings only the rate of renal damage is 14.4%. There are presently no randomized, controlled trials of treated vs untreated screened siblings with vesicoureteral reflux to evaluate health outcomes as spontaneous resolution, decreased rates of urinary infection, pyelonephritis or renal scarring. In screened populations with prenatal hydronephrosis the prevalence of vesicoureteral reflux is 16.2%. Reflux in the contralateral nondilated kidney accounted for a mean of 25.2% of detected cases for a mean prevalence of 4.1%. In patients with a normal postnatal renal ultrasound the prevalence of reflux is 17%. The prenatal anteroposterior renal pelvic diameter was not predictive of reflux prevalence. A diameter of 4 mm is associated with a 10% to 20% prevalence of vesicoureteral reflux. The prevalence of reflux is statistically significantly greater in females (23%) than males (16%) (p=0.022). Reflux grade distribution is approximately a third each for grades I-II, III and IV-V. The estimate of renal damage in screened infants without infection is 21.8%. When stratified by reflux grade renal damage was estimated to be present in 6.2% grade I-III and 47.9% grade IV-V (p <0.0001). The risk of urinary tract infection in patients with and without prenatal hydronephrosis and vesicoureteral reflux could not be determined. The incidence of reported urinary tract infection in patients with reflux was 4.2%. |
4 |
| 32. Estrada CR, Jr. Prenatal hydronephrosis: early evaluation. Curr Opin Urol. 2008;18(4):401-403. |
Review/Other-Dx |
N/A |
To address the early postnatal evaluation of the child with prenatally diagnosed hydronephrosis. |
The risk of significant urological pathology increases with the severity of prenatal hydronephrosis. The most common underlying conditions are ureteropelvic junction obstruction and vesicoureteral reflux. The use of postnatal ultrasonograpy in all patients with a history of any degree of prenatal hydronephrosis is routine, but ascertaining which patients require postnatal evaluation with a voiding cystourethrogram to investigate for vesicoureteral reflux remains controversial. Mild cases are the most controversial as the risk of pathology is lessened, however the risk of vesicoureteral reflux and consequent febrile urinary tract infection may be significant. Early postnatal evaluation of all children with a history of prenatal hydronephrosis with a voiding cystourethrogram may reduce this risk. No prospective randomized clinical trials are available, however, to adequately address the question of which patients require postnatal evaluation. |
4 |
| 33. Tibballs JM, De Bruyn R. Primary vesicoureteric reflux--how useful is postnatal ultrasound? Arch Dis Child. 1996;75(5):444-447. |
Observational-Dx |
177 patients |
To assess postnatal ultrasound findings in a population diagnosed as having antenatal hydronephrosis due solely to primary vesicoureteric reflux (VUR) to see whether this justified. |
A total of 132 (75%) were boys. Reflux was unilateral in 103 cases and bilateral in 74 (42%). Altogether 37% of boys and 33% of girls with a renal pelvic diameter of < 10 mm had grade III-V VUR. Calyceal and/or ureteric dilatation had specificities of 87-96% for grade III-V VUR, but sensitivities of only 37-54%. Fifty eight per cent of male and 75% of female renal units with grade III VUR and 17% of male units with grade IV-V VUR were normal on ultrasound. Approximately 25% of ultrasonically normal renal units had grade III-V VUR on MCU. |
3 |
| 34. Assadi F, Schloemer N. Simplified diagnostic algorithm for evaluation of neonates with prenatally detected hydronephrosis. Iran J Kidney Dis. 2012;6(4):284-290. |
Observational-Dx |
61 neonates |
To identify clinically significant urinary tract obstruction and vesicoureteral reflux (VUR) that can have negative impact on the developing kidney and to select which neonates require a full investigation and which do not in order to develop an algorithm for the postnatal evaluation of newborn with congenital hydronephrosis (CHN). |
Sixty-one neonates (47 boys and 14 girls) with CHN were enrolled. All underwent kidney ultrasonography within 72 to 96 hours after birth. Four (7%) had no residual CHN, 34 (56%) had and 23 (38%) unilateral CHN. Of the 41 newborns exposed to diuretic renography, 18 (44%) had ureteropelvic junction obstruction (UPJO). Of the 34 infants that underwent VCUG, 8 (24%) had vesicoureteral reflux (7 bilateral grade 2 or higher, 1 unilateral grade 1 CHN SFU classification). None of the unilateral grade 1 or 2 CHN due to UPJO had vesicoureteral reflux and none with vesicoureteral reflux had UPJO. Twelve patients required surgery (7 had UPJO and 3 high-grade vesicoureteral reflux). |
3 |
| 35. Berrocal T, Pinilla I, Gutierrez J, Prieto C, de Pablo L, Del Hoyo ML. Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux. Pediatr Nephrol. 2007;22(1):91-96. |
Observational-Dx |
573 neonates and infants |
To determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). |
Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. |
3 |
| 36. Koyle MA, Shifrin D. Issues in febrile urinary tract infection management. Pediatr Clin North Am. 2012;59(4):909-922. |
Review/Other-Dx |
N/A |
No objective stated in abstract. |
No results stated in abstract. |
4 |
| 37. Robinson JL, Finlay JC, Lang ME, Bortolussi R, Canadian Paediatric Society CPCID, Immunization C. Prophylactic antibiotics for children with recurrent urinary tract infections. Paediatr Child Health 2015;20:45-51. |
Review/Other-Dx |
N/A |
To examine the results of three recent significant studies, with focus on the efficacy of prophylaxis, and provide recommendations. |
No results stated in the abstract. |
4 |
| 38. Lee T, Park JM. Vesicoureteral reflux and continuous prophylactic antibiotics. Investig Clin Urol 2017;58:S32-S37. |
Review/Other-Dx |
N/A |
To describe the controversy surrounding vesicoureteral reflux (VUR) management, highlight the results of Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial, and discuss how the RIVUR findings impact our understanding of CAP in the management of VUR. |
No results stated in the abstract. |
4 |
| 39. Visuri S, Jahnukainen T, Taskinen S. Incidence of urinary tract infections in infants with antenatally diagnosed hydronephrosis-A retrospective single center study. J Pediatr Surg. 52(9):1503-1506, 2017 Sep. |
Review/Other-Dx |
192 patients (children) |
To evaluate the incidence of urinary tract infections (UTIs) in infants with antenatal hydronephrosis (AHN). |
During the median follow-up time of 2.6 (0.3–11.2) years, 24 (13%) patients (15 (10%) males and 9 (19%) females) and 2 (3%) controls experienced at least one urinary tract infections (UTI) (p = 0.033). Eighteen (69%) UTIs were febrile. The males had the first UTI at significantly younger age than the females (0.3, 0.0–1.7 years vs. 1.0, 0.4–4.8 years, p = 0.010). UTI was detected in 15 (63%) patients with grade 4–5 VUR, in 8 (6%) patients with HN, and in one (5%) patient with HUN (p-values < 0.001, 0.726 and >0.999 against the controls). None of the patients with grade =3 VUR had UTI. Fifty-eight percent of the patients with UTI were on antimicrobial prophylaxis. In five (12%) cases UTI appeared within one week after voiding cystourethrography (VCUG). |
4 |
| 40. Herndon CD, McKenna PH, Kolon TF, Gonzales ET, Baker LA, Docimo SG. A multicenter outcomes analysis of patients with neonatal reflux presenting with prenatal hydronephrosis. J Urol. 1999;162(3 Pt 2):1203-1208. |
Observational-Dx |
56 male patients; 15 female patients |
To perform a retrospective multicenter review of Society for Fetal Urology data sheets completed for each patient in whom prenatal hydronephrosis was proved to be postnatal vesicoureteral reflux from 1993 to 1998. |
In 56 male and 15 female patients with prenatal hydronephrosis a total of 116 refluxing renal units were confirmed postnatally. Of the 116 renal units 112 were hydronephrotic prenatally. During gestation increased hydronephrosis was noted with voiding in 4 cases. Of the 112 hydronephrotic renal units only 26 ureters in 15 patients were seen prenatally. The obstetrician considered the diagnosis of vesicoureteral reflux in only 24% of the cases. Postnatally 116 refluxing renal units were identified. Initial postnatal ultrasound was normal in 25% of the cases. Bilateral reflux was present in 36 male and 9 female patients. In 10 of the 19 uncircumcised patients (53%) urinary tract infection developed despite antibiotic prophylaxis. In 15 of the 74 renal units with grades III to V reflux the condition resolved at an average patient age of 0.9 and 2.1 years in boys and girls, respectively. A total of 27 refluxing renal units were reimplanted. |
3 |
| 41. Darge K, Heidemeier A. [Modern ultrasound technologies and their application in pediatric urinary tract imaging]. Radiologe. 2005;45(12):1101-1111. |
Review/Other-Dx |
N/A |
To summarize the modern ultrasound technologies and their application in pediatric urinary tract imaging. |
No results stated in abstract. |
4 |
| 42. Giordano M, Marzolla R, Puteo F, Scianaro L, Caringella DA, Depalo T. Voiding urosonography as first step in the diagnosis of vesicoureteral reflux in children: a clinical experience. Pediatr Radiol. 2007;37(7):674-677. |
Experimental-Tx |
610 patients |
To describe 6-year experience of the use of voiding urosonography (VUS) in a routine clinical setting that did not differentiate between age or sex.. |
Vesicoureteric reflux (VUR) was detected in 199 of 610 VUS examinations, and 265 refluxing kidney–ureter units were found. Children with VUR underwent antibiotic prophylaxis or surgery. Children without VUR underwent clinical followup. Just 60 children underwent voiding cystourethrography (VCUG). The criteria for VCUG were: high-grade VUR after consultation with a urologist, onset of urinary tract infection while receiving prophylaxis, nondiagnostic VUS, and other malformations with or without clinical signs. |
1 |
| 43. Kis E, Nyitrai A, Varkonyi I, et al. Voiding urosonography with second-generation contrast agent versus voiding cystourethrography. Pediatr Nephrol. 2010;25(11):2289-2293. |
Experimental-Dx |
183 children |
To evaluate the sensitivity of voiding urosonography (VUS) using a second generation ultrasound (US) contrast agent and compare it with standard fluoroscopic voiding cystourethrography (VCUG). |
Vesicoureteric reflux (VUR) was detected in 140 out of 366 cases (38%); in 89 (24.3%) by both methods, in 37 (10.1%) by VUS only, and in 14 (3.8%) by VCUG only. Although there was considerable agreement in the diagnosis of VUR by VUS and VCUG (?=0.68, standard error [?]=0.04), the difference in the detection rate of reflux between VUS and VCUG was significant (p<0.00001). The grade of VUR detected with VUS showed moderate agreement with grading by VCUG. |
3 |
| 44. Wong LS, Tse KS, Fan TW, et al. Voiding urosonography with second-generation ultrasound contrast versus micturating cystourethrography in the diagnosis of vesicoureteric reflux. Eur J Pediatr. 2014;173(8):1095-1101. |
Experimental-Dx |
31 patients |
To perform a prospective comparative study on contrast enhanced voiding urosonography (ceVUS) and micturating cystourethrography (MCU) in children with urinary tract infection. |
Perfect inter-observer agreement (Cohen’s kappa statistics=1.0, p<0.001) was achieved in ceVUS, suggesting its good reliability in reflux detection and grading. Using MCU as reference, ceVUS had 100 % sensitivity and 84 % specificity and carried higher reflux detection rate than MCU (p<0.001). There was no complication encountered. |
2 |
| 45. Wozniak MM, Wieczorek AP, Pawelec A, et al. Two-dimensional (2D), three-dimensional static (3D) and real-time (4D) contrast enhanced voiding urosonography (ceVUS) versus voiding cystourethrography (VCUG) in children with vesicoureteral reflux. Eur J Radiol. 85(6):1238-45, 2016 Jun. |
Observational-Dx |
69 patients |
To analyze if three-dimensional static (3DUS)/ four-dimensional static (4DUS) bring additional information leading to an increased detection rate or change in the grading of reflux compared to Two-dimensional (2DUS) and voiding cystouretrography. |
2DUS and 3DUS/4DUS urosonography diagnosed 10 more refluxes (7.25%) than cystourethrogra-phy and in 3 refluxes (2.17%) detected a higher grade. In 9 refluxes (6.52%) 3DUS/4DUS urosonography andcystourethrography diagnosed a higher grade than 2DUS. There was a statistically significant differencebetween cystourethrography and 3DUS/4DUS urosonography when the number of detected refluxes anddifferences in grading were compared. 4DUS enabled a better visualization of reflux than 3DUS. |
3 |
| 46. Fretzayas A, Karpathios T, Dimitriou P, Nicolaidou P, Matsaniotis N. Grading of vesicoureteral reflux by radionuclide cystography. Pediatr Radiol. 1984;14(3):148-150. |
Experimental-Dx |
36 patients |
To study 36 children with urinary tract infection aged 6 months to 14 years sequentially during direct radionuclide (RNC) and conventional voiding cystourethrography (VCU). |
Vesicoureteral reflux (VUR) was detected equally well by both methods. Twenty-seven refluxing ureters were found by RNC, 23 by VCU and 22 by both methods. Radiologic grade of reflux may be determined approximately with the isotope technique from the volume of regurgitating urine and duration of reflux, at a much decreased radiation exposure. Residual urine was also measured by RNC and found to be higher in children with VUR. |
3 |
| 47. McLaren CJ, Simpson ET. Direct comparison of radiology and nuclear medicine cystograms in young infants with vesico-ureteric reflux. BJU Int. 2001;87(1):93-97. |
Experimental-Dx |
62 infants |
To determine the sensitivity of the direct radionuclide cystogram (DRC) in detecting vesico-ureteric reflux compared with the micturating cysto-urethrogram (MCU) in the same initial setting, in infants younger than one year. |
Reflux was detected in 105 units, 96 detected on the DRC and 47 on the MCU, representing a sensitivity of 91% and 45%, respectively. The DRC missed half of grade 1, 20% of grade 2 and 6% of grade 3 reflux. Reflux at low bladder filling rates (DRC) represented 40% of all reflux units, and a half (52%) of scarred renal units detected by DMSA scintigraphy. |
3 |
| 48. Gokce I, Biyikli N, Tugtepe H, Tarcan T, Alpay H. Clinical spectrum of antenatally detected urinary tract abnormalities with respect to hydronephrosis at postnatal ultrasound scan. Pediatr Surg Int. 2012;28(5):543-552. |
Experimental-Tx |
256 infants |
To compare the outcome of infants having antenatally detected urinary tract abnormalities (AUTAs) with respect to the presence of hydronephrosis in postnatal ultrasonography (US) examination. |
The most commonly detected underlying abnormalities were ureteropelvic junction obstruction (44.8 %), vesicoureteral reflux (VUR) (30.0 %) and megaureter (9.5 %) in patients with postnatal hydronephrosis. On the other hand, multicystic dysplastic kidney (43.5 %), renal agenesis (19.4 %) and VUR (19.4 %) were mostly encountered abnormalities in patients without postnatal hydronephrosis. renal parenchymal defects (RPDs) were significantly more common among patients with postnatal hydronephrosis compared to those without hydronephrosis (37 vs. 21 %, P = 0.02). The incidence of urinary tract infection (UTI) and VUR was higher in infants with postnatal hydronephrosis than in infants without hydronephrosis. There was no statistically significant difference in terms of the development of acute kidney injury (AKI) and chronic kidney disease (CKD) and the need for surgery and dialysis treatment between patients with hydronephrosis and those without hydronephrosis. |
1 |
| 49. Alconcher LF, Tombesi MM. Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed. Pediatr Nephrol. 2012;27(7):1119-1123. |
Observational-Dx |
236 newborns |
To assess the prevalence and outcome of newborns with bilateral mild isolated antenatal hydronephrosis managed with neither antibiotic prophylaxis nor voiding cystourethrography (VCUG). |
Hydronephrosis was bilateral in 98 of the 236 newborns (196 hydronephrotic kidneys) with mild isolated antenatal hydronephrosis enrolled in this study. Nine patients had UTI, and none showed reflux. After a mean follow-up of 15 months, 74 kidneys showed intrauterine resolution (38%), 82 (42%) showed total resolution, 13 showed partial resolution, 24 were stable, and 3 showed progression. Bilateral cases represented 42% of mild isolated antenatal hydronephrosis. During the first year of life, 80% of the kidneys showed total hydronephrosis resolution, 9% of patients had UTI, and none of the patients showed reflux. |
3 |
| 50. Vemulakonda V, Yiee J, Wilcox DT. Prenatal hydronephrosis: postnatal evaluation and management. Curr Urol Rep. 2014;15(8):430. |
Review/Other-Dx |
N/A |
To discuss the current literature regarding the role of postnatal clinical and radiographic evaluation to identify children who may benefit from early surgical intervention. |
No results stated in abstract. |
4 |
| 51. Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118(2):586-593. |
Meta-analysis |
1308 patients; 17 studies |
To review the current literature to determine whether the degree of antenatal hydronephrosis and related antenatal ultrasound findings are associated with postnatal outcome. |
We screened 1645 citations, of which 17 studies met inclusion criteria. We created a data set of 1308 subjects. The risk of any postnatal pathology per degree of antenatal hydronephrosis was 11.9% for mild, 45.1% for moderate, and 88.3% for severe. There was a significant increase in risk per increasing degree of hydronephrosis. The risk of vesicoureteral reflux was similar for all degrees of antenatal hydronephrosis. |
M |
| 52. Herndon CD. Antenatal hydronephrosis: differential diagnosis, evaluation, and treatment options. ScientificWorldJournal. 2006;6:2345-2365. |
Review/Other-Dx |
N/A |
To highlight the postnatal evaluation of antenatal hydronephrosis (AH) and include an overview of the Society for Fetal Urology grading system for hydronephrosis and to discuss differential diagnosis and treatment options for ureteropelvic junction(UPJ) obstruction, vesicoureteral reflux, multi-cystic dysplastic kidney(MCDK), duplication anomalies, megaureter, and posterior urethral valves. |
No results stated in abstract. |
4 |
| 53. Herndon CD, Kitchens DM. The management of ureteropelvic junction obstruction presenting with prenatal hydronephrosis. ScientificWorldJournal. 2009;9:400-403. |
Review/Other-Tx |
N/A |
To present an appropriate algorithm and review of literature for the management of ureteropelvic junction obstruction presenting with prenatal hydronephrosis. |
No results stated in abstract. |
4 |
| 54. McMann LP, Kirsch AJ, Scherz HC, et al. Magnetic resonance urography in the evaluation of prenatally diagnosed hydronephrosis and renal dysgenesis. J Urol. 2006;176(4 Pt 2):1786-1792. |
Observational-Dx |
67 infants |
To present our experience with dynamic contrast enhanced magnetic resonance urography for evaluation and treatment in infants born with prenatally recognized hydronephrosis. |
Our study included 67 infants (87 renal units). There were 54 boys and 13 girls with a mean age of 2.8 months (range 0.9 to 4.6). Of these 87 renal units 30 (35%) had ureteropelvic junction obstruction, 18 (21%) had primary megaureters, 10 (11%) had nondilating vesicoureteral reflux, 10 (11%) had fetal folds, 8 (9%) had posterior urethral valves, 6 (7%) had ectopic ureters, 4 (5%) had multicystic dysplastic kidneys and 1 (1%) had a normal study. Magnetic resonance urography revealed renal dysgenesis in 24 renal units (28%), consisting of loss of corticomedullary differentiation, renal cystic changes distinct from multicystic dysplastic kidneys, solid renal dysplasia, hypoplasia and dysmorphic calyces. |
3 |
| 55. Yang Y, Hou Y, Niu ZB, Wang CL. Long-term follow-up and management of prenatally detected, isolated hydronephrosis. J Pediatr Surg. 2010;45(8):1701-1706. |
Observational-Dx |
629 children |
To determine the outcome and management of infants with isolated hydronephrosis, detected prenatally and confirmed postnatally. |
Initially, all of the children were treated conservatively. Stabilization occurred in all children with grade 1 hydronephrosis, in 87% of children (144) with grade 2 hydronephrosis, and in 30% of children (37) with grade 3 hydronephrosis. However, 13% of children (21) with grade 2 hydronephrosis, 70% of children (85) with grade 3 hydronephrosis, and 100% of children with grade 4 hydronephrosis received surgical intervention according to our predetermined criteria. Ninety-five patients (late pyeloplasty group) were treated for a reduction for a differential renal function (DRF) to less than 40%, and 80 children (early pyeloplasty group) underwent surgery for a DRF more than 40%, but hydronephrosis progressed to higher grades or failed to improve and had poor radiotracer clearance. Significant improvements after pyeloplasty were noted in both groups with respect to the DRF and the ratio of the depth of the calyces to the thickness of the parenchyma (C/P ratio; P < .0001). The improvement in DRF was greater in the late pyeloplasty group than the early pyeloplasty group (P = .044), whereas the improvement in the C/P ratio was greater in the early pyeloplasty group than the late pyeloplasty group (P = .001). The ipsilateral DRF was preserved in the early pyeloplasty group, whereas the ipsilateral DRF was still less than 40% in the late pyeloplasty group. The improvement in DRF was significant during the first year postoperatively and became stable thereafter. The C/P ratio was inversely correlated with the DRF in the patients before and after pyeloplasty (r = -0.257; P = .01; and r = -0.616; P = .001, respectively). |
2 |
| 56. Grazioli S, Parvex P, Merlini L, Combescure C, Girardin E. Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux. Pediatr Nephrol. 2010;25(9):1687-1692. |
Observational-Dx |
121 patients |
To analyze the relationship between the antenatal and postnatal anteroposterior diameter of renal pelvic dilatation (RPD) and the presence of reflux. |
In total, 88 patients had voiding cystourethrography (VCUG) and nine had vesicoureteral reflux (VUR), with five having high-grade reflux (>grade II). The risk of VUR increased significantly with the degree of anterior posterior diameter (APD) detected on the postnatal ultrasound scan (p=0.03). The odds ratios were 5.0 [95% confidence interval (CI) 0.5–51.2] for APD = 7–9 mm and 9.1 (95% CI 1.0–80.9) for APD =10 mm. |
3 |
| 57. Kitchens DM, Herndon CD. Antenatal hydronephrosis. Curr Urol Rep. 2009;10(2):126-133. |
Review/Other-Dx |
N/A |
To review the more common differential diagnoses of prenatal hydronephrosis and current treatment options for ureteropelvic junction obstruction, vesicoureteral reflux, ureteroceles, ectopic ureters, and megaureters. |
No results stated in abstract. |
4 |
| 58. Ditchfield MR, Grattan-Smith JD, de Campo JF, Hutson JM. Voiding cystourethrography in boys: does the presence of the catheter obscure the diagnosis of posterior urethral valves? AJR Am J Roentgenol 1995;164:1233-5. |
Observational-Dx |
48 male children |
To determine whether leaving the urethral catheter in place throughout voiding cystourethrography affects the efficacy of the procedure for the diagnosis of posterior urethral valves. |
Posterior urethral valves were detected on 25 (89%) of the 28 voiding cystourethrograms obtained with a urethral catheter in place and in 15 (88%) of the 17 voiding cystourethrograms done without a urethral catheter. The five children in whom posterior urethral valves had been diagnosed by cystoscopy but were not detected on voiding cystourethrography had no dilatation of the posterior urethra nor any other evidence of obstruction; these were possibly false-positive cystoscopic diagnoses. |
3 |
| 59. Jacobson SH, Hansson S, Jakobsson B. Vesico-ureteric reflux: occurrence and long-term risks. Acta Paediatr Suppl 1999;88:22-30. |
Review/Other-Dx |
N/A |
To see if the early diagnosis of Vesico-ureteric reflux (VUR) in the newborn period and follow-up of these patients will admit a better understanding of the natural history, the relationship to bladder dysfunction and to UTI. |
No results stated in abstract. |
4 |
| 60. Braga LH, Farrokhyar F, D'Cruz J, Pemberton J, Lorenzo AJ. Risk factors for febrile urinary tract infection in children with prenatal hydronephrosis: a prospective study. J Urol. 2015;193(5 Suppl):1766-1771. |
Observational-Dx |
334 patients |
To prospectively investigated the impact of risk factors for febrile urinary tract infection in infants with postnatally confirmed prenatal hydronephrosis. |
We collected data on 334 patients, of whom 78% were male. A febrile urinary tract infection developed in 65 patients (19%) at a median of 4 months (range 1 to 31). High grade hydronephrosis was present in 192 infants (57%). Continuous antibiotic prophylaxis was prescribed in 96 cases (29%). Of patients on continuous antibiotic prophylaxis 69% had high grade hydronephrosis. Vesicoureteral reflux was identified in 57 of 238 patients in whom voiding cystourethrogram was done. Reflux was grade I to III in 14 cases and grade IV or V in 43. Two-thirds of the patients with reflux were on continuous antibiotic prophylaxis. Circumcision was performed in 95 males (36%). Cox proportional regression identified female gender (HR 3.3, p = 0.02), uncircumcised males (HR 3.2, p = 0.02), hydroureteronephrosis (HR 10.9, p <0.01), vesicoureteral reflux (HR 20.8, p <0.01) and lack of continuous antibiotic prophylaxis (HR 5.2, p <0.01) as risk factors for febrile urinary tract infection. Subgroup analysis excluding vesicoureteral reflux showed that high grade prenatal hydronephrosis was also a significant risk factor (HR 3.0, p = 0.04). |
3 |
| 61. Taylor AT. Radionuclides in nephrourology, part 1: Radiopharmaceuticals, quality control, and quantitative indices. J Nucl Med 2014;55:608-15. |
Review/Other-Dx |
N/A |
To review information that should be provided to a patient before a radionuclide renal scintigrapy, describe the advantages and limitations of the available radiopharmaceuticals, discuss quality control elements needed to optimize a study, summarize approaches to the measurements of renal function, and focus on recommended quantitative indices and their diagnostic applications. |
No results stated in the abstract. |
4 |
| 62. Jain V, Agarwala S, Bhatnagar V, Gupta AK, Kumar R, Bal CS. Long term outcome of management of antenatally diagnosed pelvi-ureteric junction obstruction. Indian J Pediatr. 2012;79(6):769-773. |
Observational-Tx |
30 patients |
To evaluate the outcome of children with antenatally detected unilateral pelvi-ureteric junction obstruction (PUJO). |
A total of 30 children with a mean follow up of 43.3 mon were enrolled in the study. Of the 30 patients, ten had undergone early pyeloplasty and the remaining 20 were managed conservatively. Of these 20, 8 had undergone delayed pyeloplasty and the remaining 12 constituted no surgery group. Overall, 40% of patients in the present study had not required pyeloplasty till the end of the study period. The renal function in early pyeloplasty and conservative group was maintained or improved. Delayed pyeloplasty was able to restore the function in those operated for fall in function to the level that was seen at presentation. The change in renal function in between the early and delayed pyeloplasty groups was not statistically significant (p 0.97). |
2 |
| 63. Ylinen E, Ala-Houhala M, Wikstrom S. Outcome of patients with antenatally detected pelviureteric junction obstruction. Pediatr Nephrol. 2004;19(8):880-887. |
Observational-Tx |
68 patients |
To investigate the outcome of patients with antenatally detected pelviureteric junction (PUJ) obstruction treated either conservatively or surgically. |
Among the conservatively treated unilateral cases, none of the patients' good renal function deteriorated during follow-up. In the group with early surgery, the primary good function remained unchanged in all. In some patients, moderate function improved after early pyeloplasty, but in patients with poor function no improvement occurred. Of patients who underwent late pyeloplasty, primary good renal function remained unchanged in all except 1, although it had deteriorated to moderate function in some before surgery. In all except 1 patient with bilateral obstruction treated conservatively, both the grade of hydronephrosis and split function remained unchanged. In most patients the outcome of antenatally detected unilateral PUJ obstruction with initially good renal function, whether treated conservatively or surgically, seems favorable. |
2 |
| 64. Eskild-Jensen A, Gordon I, Piepsz A, Frokiaer J. Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment. J Urol. 2005;173(5):1471-1476. |
Review/Other-Dx |
N/A |
To provide an overview of the different strategies used for the treatment of congenital unilateral hydronephrosis. |
Different criteria for surgical intervention and different followup regimens have been used. Identification of the population at risk has been attempted but results are ambiguous. Surgery is done in approximately 25% of cases when using deteriorating differential function, symptoms and/or increasing hydronephrosis as criteria for operation. A nonstandardized renographic assessment does not compromise evaluation of the ideal followup but it may compromise the functional outcome. |
4 |
| 65. Piepsz A, Sixt R, Gordon I. Performing renography in children with antenatally detected pelvi-ureteric junction stenosis: errors, pitfalls, controversies. Q J Nucl Med Mol Imaging. 2010;54(4):350-362. |
Review/Other-Dx |
N/A |
To present to the reader the practical experience of three clinicians having actively participated to the publication of the guidelines on renography in children. |
No results stated in abstract. |
4 |
| 66. Chertin B, Pollack A, Koulikov D, et al. Long-term follow up of antenatally diagnosed megaureters. J Pediatr Urol. 2008;4(3):188-191. |
Observational-Dx |
79 patients |
To retrospectively evaluate 17 years of experience with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of megaureter, and tried to determine criteria for surgery. |
Twenty-five (31%) children required surgical correction. Mean age at surgery was 14.3 months (range 3-60). Univariate analysis revealed that gender and side of obstruction are not significant predictive factors for surgery Society for Fetal Urology (SFU) grade 3-4 of postnatal hydronephrosis, Relative renal function less than 30% and ureteral diameter more than 1.33 cm were significant independent risk factors leading to reimplantation. |
3 |
| 67. Shukla AR, Cooper J, Patel RP, et al. Prenatally detected primary megaureter: a role for extended followup. J Urol. 2005;173(4):1353-1356. |
Observational-Tx |
40 patients |
To analyze results with extended long-term nonsurgical treatment in a group of children diagnosed with prenatally detected primary megaureter (PM) and to determine the long-term safety of this approach and the clinical significance of residual hydroureteronephrosis (HUN) when complete resolution does not occur. |
Of 40 patients with 57 megaureters (17 with bilateral PMs) who were followed 4 infants (10%) with severe HUN were diagnosed with diminished renal function by nuclear renography and underwent surgical repair. A total of 27 infants (67.5%, 40 megaureters) with PM who were followed without surgical intervention returned for followup examination and imaging for a minimum of 24 months after initial diagnosis, for a mean of 6.8 years (range 24 to 210 months). Ultrasonography in these patients revealed complete resolution (Society for Fetal Urology grade 1 or less hydronephrosis) in 21 megaureters (52.5%) at a mean of 2.9 years and improved or stable HUN in 19 megaureters (47.5%). Antibiotic prophylaxis was administered to 12 patients beyond the first month of life and discontinued at a mean age of 19.9 months. A subgroup of 10 patients (16 megaureters) from this cohort returned for extended followup imaging at a mean of 13.4 years (range 84 to 210 months) following initial diagnosis. Four patients with documented resolution of HUN had no recurrence during long-term followup. One male with bilateral PMs diagnosed at birth that had been stable but were not resolved at 8-year followup suffered significant worsening in the degree of HUN, diminished renal function on 1 side and a renal stone on the contralateral renal unit at 14-year followup, despite remaining asymptomatic. |
2 |
| 68. Zampieri N, Zamboni C, Camoglio FS. Clinical course of grade I-III megaureters detected on prenatal ultrasound. Minerva Pediatr. 2011;63(6):439-443. |
Observational-Tx |
20 patients |
To evaluate the clinical course of grade I-III megaureter at a single Institution through a longitudinal observational study. |
Twenty patients were considered for the study. Single or relapsing infections (36% of patients had more than three urinary tract infections during follow-up) did not seem absolute indications for surgical treatment in these patients, although they are currently the first indication for surgery. |
2 |
| 69. Arena S, Magno C, Montalto AS, et al. Long-term follow-up of neonatally diagnosed primary megaureter: rate and predictors of spontaneous resolution. Scand J Urol Nephrol. 2012;46(3):201-207. |
Review/Other-Dx |
60 neonates |
To evaluate the incidence and rate of resolution of primary megaureter (PM). |
In total, 72 PM were identified in this series. At the end of the follow-up period, 38 PM (52.8%) had resolved, in 18 PM (25%) ureteral dilatation persisted and 16 PM (22.2%) required a surgical procedure. The median age at resolution was significantly affected by presenting hydronephrosis grade and cross-sectional diameter at diagnosis, but not by gender. The 99m-technetium-diethylentriaminopentaacetic acid (99mTc-DTPA) renogram results showed no functional impairment in resolved and persisting cases, even after long-term observation. |
4 |
| 70. DiRenzo D, Persico A, DiNicola M, Silvaroli S, Martino G, LelliChiesa P. Conservative management of primary non-refluxing megaureter during the first year of life: A longitudinal observational study. J Pediatr Urol. 2015;11(4):226 e221-226. |
Observational-Tx |
63 patients |
To evaluate outcomes of nonoperative management of primary nonrefluxing megaureter at long-term followup to identify clinical predictors of spontaneous resolution. |
Of the 74 primary megaureters 20 (27%) required surgery up to 7 years after diagnosis. Surgery was not indicated in 82% of primary megaureters with grade I or II hydronephrosis vs 62.9% of those with grade III or higher hydronephrosis (difference not significant), nor in 76.5% of types I and II primary megaureters vs 33.3% of type III primary megaureters (p = 0.040), 78.7% of renal units with differential function 40% or greater vs 0% with differential function less than 40% (p = 0.027), 80% of primary megaureters with a nonobstructive washout pattern vs 44.4% with an intermediate/obstructive pattern (p = 0.032), 67.9% of patients with perinatal presentation vs 25% with postneonatal presentation (p = 0.008) or 63.2% of patients presenting with symptoms vs 76.4% of those who were asymptomatic (difference not significant). On multivariate analysis age at presentation and washout pattern were significant predictors of spontaneous resolution. |
3 |
| 71. Di Renzo D, Aguiar L, Cascini V, et al. Long-term followup of primary nonrefluxing megaureter. J Urol. 2013;190(3):1021-1026. |
Observational-Tx |
47 children |
To follow the natural history of primary non-refluxing megaureter (PM) and to monitor the onset of any potential complications such as urinary tract infections (UTIs), need for hospitalization and need for surgical correction. |
Forty-seven children (44 males, three females) with 58 PM were included in the study. The participants and their corresponding outcomes are shown in the summary Table. The presence of obstruction at renogram was a significant predictor of UTIs and hospitalization. |
2 |
| 72. Farrugia MK, Hitchcock R, Radford A, Burki T, Robb A, Murphy F. British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter. J Pediatr Urol. 2014;10(1):26-33. |
Review/Other-Dx |
N/A |
To establish current United Kingdom (UK) practice and derive a consensus management strategy. |
The British Association of Paediatric Urologists (BAPU) defined a ureteric diameter over 7 mm as abnormal. The recommendation was for newborns with prenatally diagnosed hydroureteronephrosis to receive antibiotic prophylaxis and be investigated with an ultrasound scan and micturating cystourethrogram, followed by a diuretic renogram once vesicoureteral reflux (VUR) and bladder outlet obstruction had been excluded. Initial management of primary megaureters is conservative. Indications for surgical intervention include symptoms such as febrile Urinary Ttract Iinfections (UTI's) or pain, and in the asymptomatic patient, a differential renal function (DRF) below 40% associated with massive or progressive hydronephrosis, or a drop in differential function on serial renograms. The BAPU recommended a ureteral reimplantation in patients over 1 year of age but recognized that the procedure may be challenging in infancy. Proposed alternatives were the insertion of a temporary johnson and johnsen (JJ) stent or a refluxing reimplantation. |
4 |
| 73. Kumar S, Walia S, Ikpeme O, et al. Postnatal outcome of prenatally diagnosed severe fetal renal pelvic dilatation. Prenat Diagn. 2012;32(6):519-522. |
Observational-Dx |
762 patients |
To correlate the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD). |
Of the 762 patients with RPD, 492 (64.5%) were mild, 167 (21.9%) were moderate, and 103 (13.5%) were severe. The male:female ratio for the severe cohort was 5:1. Of the sever cases, 68% had progressive dilatation. Of the mild/moderate cases, 5% progressed to severe dilatation. PUJ obstruction was confirmed in 48 cases (60.8%), severe VUR in 11 cases (14%), VUJ obstruction in 5 cases (6%), PUV in 2 cases (2.5%), and a nonidentifiable cause in 13 cases (16.5%). Ten of the 48 (20.8%) babies with PUJ obstruction required surgery within the first year of life. |
3 |
| 74. Adeb M, Darge K, Dillman JR, Carr M, Epelman M. Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 2013;21(4):717-730. |
Review/Other-Dx |
N/A |
To review magnetic resonance urography in evaluation of duplicated renal collecting systems. |
No results stated in abstract. |
4 |
| 75. Rodigas J, Kirsch H, John U, et al. Static and Functional MR Urography to Assess Congenital Anomalies of the Kidney and Urinary Tract in Infants and Children: Comparison With MAG3 Renal Scintigraphy and Sonography. AJR. American Journal of Roentgenology. 211(1):193-203, 2018 Jul. |
Observational-Dx |
112 pediatric patients |
To compare functional MR urography (MRU) with the results of ultrasound and radionuclide 99mTc-mercaptoacetyltriglycine (MAG3) scintigraphy in evaluating morphologic findings, split renal function, and urinary tract obstruction in pediatric patients. |
MRU provided detailed morphologic information of the whole urinary tract for all 112 patients. In 94.6% of cases (n = 106), diagnostic findings could be verified, and in 5.4% of cases (n = 6), more detailed information could be gained. Equivalent split renal function showed good concordance between functional MRU and MAG3 scintigraphy. However, in kidneys with restricted function (< 35%), functional MRU underestimated the remaining renal function, with a mean difference of 6.6% and an SD of 24.4%. For evaluation of relevant urinary tract obstruction, the sensitivity of functional MRU was 100%, specificity was 81.6%, positive predictive value was 70.8%, and negative predictive value was 100%. |
3 |
| 76. Claudon M, Durand E, Grenier N, et al. Chronic urinary obstruction: evaluation of dynamic contrast-enhanced MR urography for measurement of split renal function. Radiology. 273(3):801-12, 2014 Dec. |
Observational-Dx |
369 pediatric and adult patients |
To evaluate if measurement of split renal function (SRF split renal function) with dynamic contrast material-enhanced (DCE dynamic contrast enhanced) magnetic resonance (MR) urography is equivalent to that with renal scintigraphy (RS renal scintigraphy) in patients suspected of having chronic urinary obstruction. |
Reproducibility was substantial to almost perfect for both methods. Equivalence of DCE dynamic contrast enhanced MR urography and RS renal scintigraphy for measurement of SRF split renal function was shown in patients with moderately dilated kidneys (P < .001 with the Patlak-Rutland method). However, in severely dilated kidneys, the mean SRF split renal function measurement was underestimated by 4% when DCE dynamic contrast enhanced MR urography was used compared with that when RS renal scintigraphy was used. Age and type of MR imaging device had no significant effect. |
2 |
| 77. Duong HP, Piepsz A, Collier F, et al. Predicting the clinical outcome of antenatally detected unilateral pelviureteric junction stenosis. Urology. 2013;82(3):691-696. |
Observational-Tx |
161 patients |
To determine, in children with antenatally detected pelviureteric junction (PUJ) stenosis, what factors may be predictive for deterioration of differential renal function (DRF) in case of conservative treatment or improvement of DRF in case of pyeloplasty. |
Fifty patients never underwent a surgical intervention (62%), whereas surgical repair (Anderson-Hynes dismembered pyeloplasty) was performed in 31 (38%). During conservative follow-up, DRF deterioration was observed in 11% of patients. After pyeloplasty, DRF improvement was observed in 25% of patients. Abnormal cortical transit was the only predictive factor of DRF deterioration in case of conservative approach, whereas the initial degree of hydronephrosis, or renal drainage, and the initial DRF level were not predictive. In children who were operated on, only impaired cortical transit was predictive of DRF improvement postoperatively. |
3 |
| 78. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
