Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction

Abstract

Purpose: In this study we 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.

Materials and methods: Between 1999 and 2010, 371 newborns diagnosed with isolated prenatal hydronephrosis were prospectively followed. The main event of interest was the need for pyeloplasty. Diagnostic odds ratio, sensitivity, specificity and diagnostic accuracy (assessed by AUC) of fetal renal pelvic dilatation and postnatal renal pelvic dilatation were evaluated.

Results: 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).

Conclusions: Our findings suggest that the combination of fetal and postnatal renal pelvic dilatation is able to increase the diagnostic accuracy for detecting infants who need a more comprehensive postnatal investigation for upper urinary tract obstruction.

Keywords: (99)mtechnetium; (99m)Tc; ANH; APD; DMSA; DOR; LR; NPV; PPV; RPD; SFU; Society for Fetal Urology; UPJO; US; VUR; anteroposterior diameter; diagnosis; diagnostic odds ratio; dimercapto-succinic acid; fetus; hydronephrosis; likelihood ratio; negative predictive value; positive predictive value; prenatal hydronephrosis; renal pelvic dilatation; ultrasound; ureteral obstruction; ureteropelvic junction obstruction; urinary tract infections; vesicoureteral reflux.