Validation of modified diuretic drainage times criteria in congenital hydronephrosis

  • Amr Hodhod
    Divisions of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada

    Division of Pediatric Urology, Department of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
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  • Sophie Turpin
    Divisions of Nuclear Medicine, Departments of Radiology, Montreal Children's Hospital and CHU Sainte-Justine, McGill University and Université de Montreal, Montreal, Quebec, Canada
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  • Francis Petrella
    Divisions of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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  • Roman Jednak
    Divisions of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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  • Mohamed El-Sherbiny
    Divisions of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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  • John-Paul Capolicchio
    Correspondence to: John-Paul Capolicchio, The Montreal Children's Hospital, Room B04.2916.4, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada, Fax: +1514 412 4384
    Divisions of Urology, Departments of Pediatric Surgery and Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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      Introduction and objective

      The value of diuretic renography drainage times in congenital hydronephrosis (AHN) decision making is controversial. Recently, a group suggested a modification to the classically described diuretic drainage time cut-off values. They found that a drainage half-time (T1/2) < 5 min was normal whereas a T1/2 exceeding 75 min predicted pyeloplasty. In addition, they reported on the benefit of a delayed drainage image obtained with gravity assistance. We sought to evaluate the ability of these modified T1/2 criteria to predict pyeloplasty, alone or in combination with a delayed drainage image referred to as Global Washout (GWO).


      We retrospectively reviewed 113 patients, including consecutive pyeloplasties for AHN from 2004 to 2018. Patients who underwent pyeloplasty due to low differential renal function (DRF) < 30% or infection were excluded. The control group comprised high grade AHN managed non-operatively. The initial renal ultrasound and MAG 3 Lasix renogram were reviewed for grade, differential renal function (DRF), T1/2 and GWO. A ROC curve was used to evaluate the T1/2 and GWO cut-off points that can predict pyeloplasty, using a p-value of less than 0.05.


      The pyeloplasty group consisted of 62 patients and the control group consisted of 51 patients. Two patients (3%) in the pyeloplasty group had a T1/2 < 5 min whereas 21 (34%) had T 1/2 > 75 min (p < 0.001). In the control group, 25 patients (49%) had T 1/2 < 5 min and none had T1/2 >75 min (P < 0.001). The ROC curve for T1/2 < 5 min demonstrated 94% sensitivity and 51% specificity whereas a T1/2 >75 min demonstrated 100% specificity and 34% sensitivity. Analysis of the GWO using a ROC curve revealed that a cut-off of 50% GWO has 100% specificity and 52% sensitivity for pyeloplasty. Overall, a T1/2 > 75 min or GWO <50% predicted 53% of pyeloplasties (Fig A) and was absent in all conservatively managed cases.


      The limitations of the present study include its retrospective nature. Secondly, the lack of a gold standard diagnostic test for uretero-pelvic junction obstruction hampers objective quantification of diagnostic test utility performance.


      Summary Figure A
      Graphical AbstractAbility of the modified drainage criteria to predict pyeloplasty.


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