Advertisement
Research Article| Volume 19, ISSUE 1, P75-82, February 2023

Download started.

Ok

How can we measure the renal pelvic anteroposterior diameter in postnatal isolated hydronephrosis?

      Summary

      Introduction

      The anteroposterior diameter (APD) of the renal pelvis is a commonly used ultrasound parameter in the evaluation and management of hydronephrosis. It has been established that an APD value associated with pyeloplasty is around 25 mm. Some believe the APD should be measured at the innermost part of the renal pelvis while others suggest that it should be done at the renal contour. However, there is no consensus on the optimal APD measurement technique including whether it should be measured supine or prone. This study compared six different techniques of APD measurements, in both supine and prone positions, and further evaluated their association with pyeloplasty.

      Methods

      Data was obtained by retrospectively reviewing patients’ charts that had initial high-grade hydronephrosis (HGH) from 2008 to 2014. We recorded the patients’ demographics, ultrasound data and management choice. In the mid-renal transverse plane, the APD was measured by 2 blinded investigators, at the intra-renal, renal contour and extra-renal regions of the renal pelvis in supine and prone positions (Figure A). We compared the six APD measurements based on the outcome of management (pyeloplasty vs. conservative management). The ROC curve obtained was then used to assess the ability of various APD measurements in predicting surgical intervention. The cutoff value chosen that predicts pyeloplasty was the lowest diameter with 100% specificity.

      Results

      We included 129 patients (134 renal units). Forty-four renal units (42 patients) underwent pyeloplasty whereas 90 renal units (87 patients) were managed conservatively. Patients’ demographics were grouped by both SFU grade and clinical outcome. Regardless of grade, the APD measurements were different in all 6 techniques. All APD measurement techniques showed good inter-rater reliability. Based on the ROC curve, all APD measurements were associated with pyeloplasty with an AUC from 0.89 to 0.91. The supine extra-renal APD measurement of 24 mm was the most sensitive cutoff value. The cutoff values ranged from 18 to 27 mm when including patients from all grades of hydronephrosis. The median APD measurements were significantly less for SFU grade 3 than grade 4 hydronephrosis in all positions (P < 0.001 for all measurements), yet the predictive cutoff value of 24 mm for the supine extra-renal was similar for both grades.

      Conclusion

      Summary Figure
      Graphical AbstractIllustrates how APD was measured in supine (a) and prone (b) transverse mid-renal views at the intrarenal pelvis, renal contour and extrarenal pelvis locations.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gunn T.R.
        • Mora J.D.
        • Pease P.
        Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks' gestation: incidence and outcome.
        Am J Obstet Gynecol. 1995; 172: 479-486
        • Grandjean H.
        • Larroque D.
        • Levi S.
        The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study.
        Am J Obstet Gynecol. 1999; 181: 446-454
        • Sairam S.
        • Al-Habib A.
        • Sasson S.
        • Thilaganathan B.
        Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound.
        Ultrasound Obstet Gynecol: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001; 17: 191-196
        • Ismaili K.
        • Hall M.
        • Donner C.
        • Thomas D.
        • Vermeylen D.
        • Avni F.E.
        Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population.
        Am J Obstet Gynecol. 2003; 188: 242-246
        • Szymanski K.M.
        • Al-Said A.N.
        • Pippi Salle J.L.
        • Capolicchio J.P.
        Do infants with mild prenatal hydronephrosis benefit from screening for vesicoureteral reflux?.
        J Urol. 2012; 188: 576-581
        • Capolicchio J.P.
        • Braga L.H.
        • Szymanski K.M.
        Canadian Urological Association/Pediatric Urologists of Canada guideline on the investigation and management of antenatally detected hydronephrosis.
        Can Urol Assoc J. 2018; 12: 85-92
        • Coelho G.M.
        • Bouzada M.C.F.
        • Pereira A.K.
        • Figueiredo B.F.
        • Leite M.R.S.
        • Oliveira D.S.
        • et al.
        Outcome of isolated antenatal hydronephrosis: a prospective cohort study.
        Pediatr Nephrol. 2007; 22: 1727-1734
        • Capolicchio G.
        • Leonard M.P.
        • Wong C.
        • Jednak R.
        • Brzezinski A.
        • Salle J.L.
        Prenatal diagnosis of hydronephrosis: impact on renal function and its recovery after pCan Urol Assoc Jyeloplasty.
        J Urol. 1999; 162: 1029-1032
        • Longpre M.
        • Nguan A.
        • MacNeily A.E.
        • Afshar K.
        Prediction of the outcome of antenatally diagnosed hydronephrosis: a multivariable analysis.
        J Pediatr Urol. 2012; 8: 135-139
        • Arora S.
        • Yadav P.
        • Kumar M.
        • Singh S.K.
        • Sureka S.K.
        • Mittal V.
        • et al.
        Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction--a prospective multivariate analysis.
        J Pediatr Urol. 2015; 11: 248 e1-5
        • Hodhod A.
        • Capolicchio J.-P.
        • Jednak R.
        • El-Sherif E.
        • El-Doray A.E.-A.
        • El-Sherbiny M.
        Evaluation of urinary tract dilation classification system for grading postnatal hydronephrosis.
        J Urol. 2016; 195: 725-730
        • Berdon W.E.
        • Baker D.H.
        • Leonidas J.
        Advantages of prone positioning in gastrointestinal and genitourinary roentgenologic studies in infants and children.
        Am J Roentgenol. 1968; 103: 444-455
        • Carrico C.W.
        • Zerin J.M.
        Sonographic measurement of renal length in children: does the position of the patient matter?.
        Pediatr Radiol. 1996; 26: 553-555
        • De Sanctis J.T.
        • Connolly S.A.
        • Bramson R.T.
        Effect of patient position on sonographically measured renal length in neonates, infants, and children.
        AJR Am J Roentgenol. 1998; 170: 1381-1383
        • Nakamura M.
        • Taniguchi N.
        • Kawai F.
        • Yokota K.
        • Ono T.
        • Wang Y.
        • et al.
        Sonographic measurement of renal length in children: variation associated with body position.
        J Med Ultrason. 2003; 30: 187-192
        • Riccabona M.
        • Avni F.E.
        • Blickman J.G.
        • Dacher J.-N.
        • Darge K.
        • Lobo M.L.
        • 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: 138-145
        • Sharma G.
        • Sharma A.
        • Maheshwari P.
        Predictive value of decreased renal pelvis anteroposterior diameter in prone position for prenatally detected hydronephrosis.
        J Urol. 2012; 187: 1839-1843
        • Websteb Biggs J.
        • Hagood J.H.
        • Andrews A.
        Anatomic changes in the normal urinary tract between supine and prone urograms.
        Radiology. 1970; 94: 107-113
        • Nelson C.P.
        • Lee R.S.
        • Trout A.T.
        • Servaes S.
        • Kraft K.H.
        • Barnewolt C.E.
        • et al.
        The association of postnatal urinary tract dilation risk score with clinical outcomes.
        J Pediatr Urol. 2019; 15: 341 e1-e6
        • Hodhod A.
        • Turpin S.
        • Petrella F.
        • Jednak R.
        • El-Sherbiny M.
        • Capolicchio J.P.
        Validation of modified diuretic drainage times criteria in congenital hydronephrosis.
        J Pediatr Urol. 2021; 17: 832 e1-e8
        • Dias C.S.
        • Silva J.M.
        • Pereira A.K.
        • Marino V.S.
        • Silva L.A.
        • Coelho A.M.
        • et al.
        Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction.
        J Urol. 2013; 190: 661-666
        • Zhang L.
        • Li Y.
        • Liu C.
        • Li X.
        • Sun H.
        Diagnostic value of anteroposterior diameter of renal pelvis for predicting postnatal surgery: a systematic review and meta-analysis.
        J Urol. 2018; 200: 1346-1353
        • Nguyen H.T.
        • Benson C.B.
        • Bromley B.
        • Campbell J.B.
        • Chow J.
        • Coleman B.
        • et al.
        Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system).
        J Pediatr Urol. 2014; 10: 982-998
        • Romao R.L.
        • Farhat W.A.
        • Pippi Salle J.L.
        • Braga L.H.
        • Figueroa V.
        • Bagli D.J.
        • et al.
        Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction.
        J Urol. 2012; 188: 2347-2353
        • Sharma G.
        • Sharma A.
        • Maheshwari P.
        Predictive value of decreased renal pelvis anteroposterior diameter in prone position for prenatally detected hydronephrosis.
        J Urol. 2012; 187: 1839-1843
        • Rickard M.
        • Braga L.H.
        • Oliveria J.P.
        • Romao R.
        • Demaria J.
        • Lorenzo A.J.
        Percent improvement in renal pelvis antero-posterior diameter (PI-APD): prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone.
        J Pediatr Urol. 2016; 12: 228 e1-6
        • Calle-Toro J.S.
        • Maya C.L.
        • Gorfu Y.
        • Dunn E.
        • Darge K.
        • Back S.J.
        Supine versus prone positioning for ultrasound evaluation of postnatal urinary tract dilation in children.
        Pediatr Radiol. 2020; 50: 357-362
        • Keays M.A.
        • Guerra L.A.
        • Mihill J.
        • Raju G.
        • Al-Asheeri N.
        • Geier P.
        • et al.
        Reliability assessment of Society for Fetal Urology ultrasound grading system for hydronephrosis.
        J Urol. 2008; 180 (; discussion2-3): 1680-1682
        • Vemulakonda V.M.
        • Wilcox D.T.
        • Torok M.R.
        • Hou A.
        • Campbell J.B.
        • Kempe A.
        Inter-rater reliability of postnatal ultrasound interpretation in infants with congenital hydronephrosis.
        Int Urol Nephrol. 2015; 47: 1457-1461
        • Ulman I.
        • Jayanthi V.R.
        • Koff S.A.
        The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively.
        J Urol. 2000; 164: 1101-1105
        • Hodhod A.
        • El-Sherbiny M.
        • Jednak R.
        • Capolicchio J.P.
        How can we quantify worsening hydronephrosis on ultrasound?.
        SPU Fall Congress. 2017;

      Linked Article