Advertisement

Associations, follow up data, and postnatal outcome of antenatally diagnosed Urinary Tract Dilatation - Five-year single tertiary center experience from South India

Published:October 27, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.10.028

      Summary

      Background

      Urinary tract dilatations (UTD) are frequently diagnosed during Mid-Trimester Anomaly Scan (MTAS), at which time, given their variable progression and heterogeneous classification systems, offering suitable counsel to the couple is challenging.

      Objective

      Based on postnatal data, we aimed to guide parental counseling, and further evaluation of UTD diagnosed at MTAS. Specifically, the utility of multi-disciplinary UTD classification system was tested.

      Methods

      A retrospective observational study of all UTDs included from five years (2015–2020) MTAS register. The multi-disciplinary UTD classification system was used for antenatal/postnatal UTD categorization. Follow-up data were obtained from case records until the current age of children (2–6 years).

      Results

      Out of 527 fetal abnormalities, 103 had UTD at MTAS. Based on the third-trimester ultrasound, 49 were low-risk UTD A1, and 44 were increased-risk UTD A2-3 (including the nineteen UTD A1 at MTAS worsened to A2-3 by third-trimester). On postnatal follow-up of UTD A1 and A2-3, respectively, neonatal UTD P2/P3 was seen in 2% and 40.9%; complete spontaneous resolution was seen in 79.5% and 43.18%; none and 22.7% underwent surgical intervention; persistent P2/P3 UTD were seen on follow-up in 2% and 4.5% (excluding those who needed surgery); impaired renal function was seen in none and 36.3%, and recurrent UTI in 8.1% and 34.09%. The subgroup with progressive UTD (from A1 to A2-3 by third-trimester ultrasound) formed 43% of the final UTD A2-3 category. Among these 19 cases, surgical intervention was performed in eight (42%); impaired renal function was seen in 7 cases (36.8%), and recurrent UTI was seen in eight (42%).

      Discussion

      Given the diverse classification systems for UTD, ours is the second Indian data proving the prognostic utility of multi-disciplinary UTD classification system, specifically at third trimester scan, based on postnatal outcome. In contrast to published guidelines, our data suggests follow-up for renal pelvis anteroposterior diameter (APD) of 4–7 mm at MTAS, as some may worsen. Similar progression has been noted in other Indian studies, but the classification systems are different. Contrary to the published literature, we could not suggest a renal APD cut-off as a single criterion to predict surgical intervention. Significant limitations are retrospective observational design and multiple sonographers.

      Conclusion

      Summary Figure
      Graphical AbstractPostnatal diagnosis of UTD.

      Keywords

      Abbreviations:

      APD (Anteroposterior Diameter), MTAS (Mid-Trimester Anomaly Scan), MTP (Medical termination of pregnancy), UTD (Urinary tract dilatation)
      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

        • 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 Dec 1; 10: 982-998
        • Andrés-Jensen L.
        • Jørgensen F.S.
        • Thorup J.
        • Flachs J.
        • Madsen J.L.
        • Maroun L.L.
        • et al.
        The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort.
        Arch Dis Child. 2016 Sep 1; 101: 819-824
        • John U.
        • Kähler C.
        • Schulz S.
        • Mentzel H.J.
        • Vogt S.
        • Misselwitz J.
        The impact of fetal renal pelvic diameter on postnatal outcome.
        Prenat Diagn. 2004 Aug; 24 (Published in Affiliation With the International Society for Prenatal Diagnosis): 591-595
        • 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 Aug 1; 15: 341-e1
        • Kaspar C.D.
        • Lo M.
        • Bunchman T.E.
        • Xiao N.
        The antenatal urinary tract dilation classification system accurately predicts severity of kidney and urinary tract abnormalities.
        J Pediatr Urol. 2017 Oct 1; 13: 485-e1
        • Singh N.
        • Bansal V.
        • Satoskar P.
        • Faisal S.
        A retrospective analysis to evaluate role of the new UTD classification system in prenatal prediction of severity and postnatal outcome in antenatally diagnosed urinary tract dilatation abnormalities.
        J Obstet Gynaecol India. 2021 Feb 26; : 1-9
        • Kumar M.
        • Thakur S.
        • Puri A.
        • Shukla S.
        • Sharma S.
        • Perumal V.
        • et al.
        Fetal renal anomaly: factors that predict survival.
        J Pediatr Urol. 2014 Dec 1; 10: 1001-1007
        • Balthazar A.
        • Herndon C.A.
        Prenatal urinary tract dilatation.
        Urologic Clinics. 2018 Nov 1; 45: 641-657
        • Cherian A.G.
        • Jacob T.J.
        • Sebastian T.
        • Vijayaselvi R.
        • David L.S.
        • Kumar M.
        • et al.
        Postnatal outcomes of babies diagnosed with hydronephrosis in utero in a tertiary care centre in India over half a decade.
        Case Rep Perinat Med. 2019 Sep 1; 8
        • Ramesh Babu V.S.
        Postnatal outcome of fetal hydronephrosis: implications for prenatal counselling.
        Indian J Urol: IJU. 2010 Jan; 26 (journal of the Urological Society of India): 60
        • Hodhod A.
        • Capolicchio J.P.
        • Jednak R.
        • El-Sherif E.
        • El-Doray A.E.
        • El-Sherbiny M.
        Evaluation of urinary tract dilation classification system for grading postnatal hydronephrosis.
        J Urol. 2016 Mar 1; 195: 725-730
        • Baker Z.G.
        • Hannallah A.
        • Trabold M.
        • Estell D.
        • Deng C.
        • Chang A.Y.
        • et al.
        Association between severity of prenatally diagnosed hydronephrosis and receipt of surgical intervention postnatally among patients seen at a fetal-maternal center.
        BMC Urol. 2021 Dec; 21: 1-8
        • Pan P.
        The fate of antenatal renal pelvis dilatation: a prospective postnatal cohort study.
        Int J Contemp Pediatr. 2019 Jul; 6: 1646
        • Vemulakonda V.
        • Yiee J.
        • Wilcox D.T.
        Prenatal hydronephrosis: postnatal evaluation and management.
        Curr Urol Rep. 2014 Aug 1; 15: 430
        • Salomon L.J.
        • Alfirevic Z.
        • Berghella V.
        • Bilardo C.M.
        • Chalouhi G.E.
        • Costa F.D.
        • et al.
        ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan.
        Ultrasound Obstet Gynecol: Off J Int Soc Ultrasound Obstetr Gynecol. 2022; 59: 840-856
        • Nef S.
        • Neuhaus T.J.
        • Spartà G.
        • Weitz M.
        • Buder K.
        • Wisser J.
        • et al.
        Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.
        Eur J Pediatr. 2016 May 1; 175: 667-676
        • Melcer Y.
        • Kaplan G.
        • Ben-Ami I.
        • Bahat H.
        • Neheman A.
        • Galoyan N.
        • et al.
        Termination of pregnancy due to renal tract abnormalities: survey of 97 fetuses from a single medical center.
        Prenat Diagn. 2017 Mar; 37: 215-221
        • Danziger P.
        • Berman D.R.
        • Luckritz K.
        • Arbour K.
        • Laventhal N.
        Severe congenital anomalies of the kidney and urinary tract: epidemiology can inform ethical decision-making.
        J Perinatol. 2016 Nov; 36: 954-959
        • Marokakis S.
        • Kasparian N.A.
        • Kennedy S.E.
        Parents' perceptions of counselling following prenatal diagnosis of congenital anomalies of the kidney and urinary tract: a qualitative study.
        BJU Int. 2017 Mar; 119: 474-481