Summary
Introduction
Prior studies with postnatal ultrasound measurements of the medullary pyramid thickness
(PT) demonstrate a PT < 3 mm as a significant risk factor for the diagnosis of UPJ
obstruction and pyeloplasty. These studies used the postnatal ultrasound demonstrating
the largest degree of hydronephrosis. Since early identification of children at increased
risk of obstruction and pyeloplasty would be clinically useful, we reviewed the PT
on the first and second postnatal ultrasound in infants with congenital hydronephrosis.
Objective
The aims of the study were to determine the prognostic value of: 1) PT on the first
and second postnatal ultrasound, 2) a change in PT between first and second ultrasounds,
and 3) ratio of PT in the hydronephrotic kidney to the contralateral PT in the normal
kidney in those with unilateral hydronephrosis. We hypothesized that a smaller PT
on either the first or second ultrasound, as well as a decreasing PT between the first
and second ultrasound, and a decreased ratio of hydronephrotic PT to the contralateral
normal kidney, would each be early predictors of subsequent pyeloplasty.
Study design
A retrospective chart and ultrasound review of children with a diagnosis of isolated
high grade (SFU grade 3 or 4) hydronephrosis was performed. This study also analyzed
the impact on predictive ability of the PT obtained on an ultrasound obtained before
3 days of life compared to those in which the first ultrasound was obtained after
3 days of life. 91 infants (77 boys and 14 girls) met eligibility criteria (105 kidneys).
The median age (IQR) at first ultrasound was 1.5 (1.0–15.0) days and 54.0 (27.5–123.0)
days at the second ultrasound.
Discussion and conclusion
Graphical AbstractA. PT measurement in hydronephrotic kidney. B. PT measurement in normal contralateral
kidney.
Keywords
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References
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Article info
Publication history
Published online: January 10, 2023
Accepted:
January 5,
2023
Received in revised form:
December 23,
2022
Received:
October 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
