TY - JOUR
T1 - Fetal hydronephrosis as a predictor of neonatal urologic outcomes
AU - Shamshirsaz, Alireza A.
AU - Ravangard, Samadh F.
AU - Egan, James F.
AU - Prabulos, Ann Marie
AU - Shamshirsaz, Amirhoushang A.
AU - Ferrer, Fernando A.
AU - Makari, John H.
AU - Leftwich, Heidi K.
AU - Herbst, Katherine W.
AU - Billstrom, Rachel A.
AU - Sadowski, Allison
AU - Gurram, Padmalatha
AU - Campbell, Winston A.
PY - 2012/6/1
Y1 - 2012/6/1
N2 - Objectives - The ability to predict surgically relevant fetal renal hydronephrosis is limited. We sought to determine the most efficacious second- and third-trimester fetal renal pelvis anteroposterior diameter cutoffs to predict the need for postnatal surgery. Methods - We retrospectively reviewed the medical records of mothers and neonates who had a prenatal sonographic examination in our Perinatal-Pediatric Urology Clinic and received follow-up care. Hydronephrosis was defined as a renal pelvis anteroposterior diameter of 5 mm or greater in the second trimester and 7 mm or greater in the third trimester. Hydronephrosis was subdivided into mild, moderate, and severe. Results - Of 8453 fetuses, 96 met the criteria and were referred to our clinic. Isolated hydronephrosis was diagnosed in 74 fetuses, of which 53 received postnatal follow-up evaluations. The areas under the receiver operating characteristic curves for predicting postnatal surgery in the second and third trimesters were 0.770 and 0.899, respectively. The second-trimester renal anteroposterior diameter threshold that best predicted postnatal surgery was 9.5 mm (sensitivity, 71.4%; specificity, 81.1%). The third-trimester threshold that best predicted postnatal surgery was 15.0 mm (sensitivity, 85.7%; specificity, 94.6%). Conclusions - The fetal renal anteroposterior diameter on second- and third-trimester sonography is predictive of an increased risk for neonatal urologic surgery. Surgical risk is best predicted by a third-trimester renal anteroposterior diameter threshold of 15 mm.
AB - Objectives - The ability to predict surgically relevant fetal renal hydronephrosis is limited. We sought to determine the most efficacious second- and third-trimester fetal renal pelvis anteroposterior diameter cutoffs to predict the need for postnatal surgery. Methods - We retrospectively reviewed the medical records of mothers and neonates who had a prenatal sonographic examination in our Perinatal-Pediatric Urology Clinic and received follow-up care. Hydronephrosis was defined as a renal pelvis anteroposterior diameter of 5 mm or greater in the second trimester and 7 mm or greater in the third trimester. Hydronephrosis was subdivided into mild, moderate, and severe. Results - Of 8453 fetuses, 96 met the criteria and were referred to our clinic. Isolated hydronephrosis was diagnosed in 74 fetuses, of which 53 received postnatal follow-up evaluations. The areas under the receiver operating characteristic curves for predicting postnatal surgery in the second and third trimesters were 0.770 and 0.899, respectively. The second-trimester renal anteroposterior diameter threshold that best predicted postnatal surgery was 9.5 mm (sensitivity, 71.4%; specificity, 81.1%). The third-trimester threshold that best predicted postnatal surgery was 15.0 mm (sensitivity, 85.7%; specificity, 94.6%). Conclusions - The fetal renal anteroposterior diameter on second- and third-trimester sonography is predictive of an increased risk for neonatal urologic surgery. Surgical risk is best predicted by a third-trimester renal anteroposterior diameter threshold of 15 mm.
KW - Hydronephrosis
KW - Pyelectasis
KW - Sonography
KW - Surgery
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U2 - 10.7863/jum.2012.31.6.947
DO - 10.7863/jum.2012.31.6.947
M3 - Article
C2 - 22644692
AN - SCOPUS:84864191842
SN - 0278-4297
VL - 31
SP - 947
EP - 954
JO - Journal of Ultrasound in Medicine
JF - Journal of Ultrasound in Medicine
IS - 6
ER -