Treatment of Infants with Ureteropelvic Junction Obstruction: Findings from the PURSUIT Network

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2021 May 5

PMID 33948809

Citations 4

Authors

Vijaya M Vemulakonda

Carter Sevick

Elizabeth Juarez-Colunga

George Chiang

Nicolette Janzen

Alison Saville

Parker Adams

Gemma Beltran

Jordon King

Emily Ewing

Allison Kempe

Affiliations

Soon will be listed here.

Abstract

Purpose: Studies based on administrative databases show that infant pyeloplasty is associated with minority race/ethnicity but lack clinical data that may influence treatment. Our objective was to identify clinical and demographic factors associated with pyeloplasty in infants from three large tertiary centers.

Methods: We reviewed infants with unilateral Society for Fetal Urology (SFU) grade 3-4 hydronephrosis seen at three tertiary centers from 2/1/2018 to 9/30/2019. Patients were excluded if > 6 months old or treated surgically prior to the initial visit. Outcomes were: pyeloplasty < age 1 year and SFU grade on most recent ultrasound (US) within the first year. Covariables included: age at the initial visit, race/ethnicity, treating site, insurance type, febrile UTI, and initial imaging findings. Univariable and multivariable analyses were performed using log-rank tests and Cox proportional hazards models, respectively.

Results: 197 patients met study criteria; 19.3% underwent pyeloplasty. Pyeloplasty was associated with: treating site (p = 0.03), SFU 4 on initial US (p = 0.001), MAG-3 (p < 0.001), and T½ > 20 min (p < 0.001) in patients undergoing a MAG-3 (n = 107). MAG-3 (p < 0.001) and location (p = 0.08) were associated with earlier time to pyeloplasty on multivariable Cox analysis. In infants with follow-up US (n = 115), initial SFU grade, MAG-3 evaluation or findings, and pyeloplasty were not associated with improvement of hydronephrosis.

Conclusions: We found that infant pyeloplasty rates vary between sites. Prolonged T½ was associated with surgery despite prior studies suggesting this is a poor predictor of worsening dilation or function. These findings suggest the need to standardize evaluation and indications for intervention in infants with suspected UPJ obstruction.

Citing Articles

Postnatal Calyceal-to-Parenchymal Ratio: A Promising Predictor for Surgical Correction of Ureteropelvic Junction Obstruction in Newborns.

Almodhen F, Moneir W, Bashareef A, Al-Zahrani A, Alaqeel A, Alhams A Cureus. 2023; 15(11):e48466.

PMID: 38073959 PMC: 10703515. DOI: 10.7759/cureus.48466.

Epidemiology of Infantile Ureteropelvic Junction Obstruction in the US.

Fwu C, Barthold J, Mendley S, Bennett K, Chan K, Wilkins K Urology. 2023; 183:185-191.

PMID: 37802192 PMC: 10843281. DOI: 10.1016/j.urology.2023.09.024.

Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.

Buchanan C, Morris M, Matlock D, Kempe A, Vemulakonda V PEC Innov. 2023; 2:100142.

PMID: 37588298 PMC: 10426279. DOI: 10.1016/j.pecinn.2023.100142.

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?.

Kang B, Suh J, Lim B, Kim K, Song S J Clin Med. 2022; 11(19).

PMID: 36233520 PMC: 9570754. DOI: 10.3390/jcm11195651.

References

Chalmers D, Deakyne S, Payan M, Torok M, Kahn M, Vemulakonda V . Feasibility of integrating research data collection into routine clinical practice using the electronic health record. J Urol. 2014; 192(4):1215-20. DOI: 10.1016/j.juro.2014.04.091. View

Riccabona M, Avni F, Blickman J, Dacher J, Darge K, Lobo M . 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. 2007; 38(2):138-45. DOI: 10.1007/s00247-007-0695-7. View

Harper L, Bourquard D, Grosos C, Abbo O, Ferdynus C, Michel J . Cortical transit time as a predictive marker of the need for surgery in children with pelvi-ureteric junction stenosis: preliminary study. J Pediatr Urol. 2013; 9(6 Pt B):1054-8. DOI: 10.1016/j.jpurol.2013.03.002. View

Riccabona M, Avni F, Blickman J, Dacher J, Darge K, Lobo M . Imaging recommendations in paediatric uroradiology. Minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR Annual Congress,.... Pediatr Radiol. 2009; 39(8):891-8. DOI: 10.1007/s00247-009-1233-6. View

Black C, Sharma P, Scotland G, McCullough K, McGurn D, Robertson L . Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess. 2010; 14(21):1-184. DOI: 10.3310/hta14210. View

Koff S . Requirements for accurately diagnosing chronic partial upper urinary tract obstruction in children with hydronephrosis. Pediatr Radiol. 2007; 38 Suppl 1:S41-8. DOI: 10.1007/s00247-007-0590-2. View

Weitz M, Portz S, Laube G, Meerpohl J, Bassler D . Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age. Cochrane Database Syst Rev. 2016; 7:CD010716. PMC: 6457949. DOI: 10.1002/14651858.CD010716.pub2. View

Nguyen H, Herndon C, Cooper C, Gatti J, Kirsch A, Kokorowski P . The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010; 6(3):212-31. DOI: 10.1016/j.jpurol.2010.02.205. View

Arora S, Yadav P, Kumar M, Singh S, Sureka S, Mittal V . Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction--a prospective multivariate analysis. J Pediatr Urol. 2015; 11(5):248.e1-5. DOI: 10.1016/j.jpurol.2015.02.008. View

10.

Vemulakonda V, Wilcox D, Torok M, Hou A, Campbell J, Kempe A . Inter-rater reliability of postnatal ultrasound interpretation in infants with congenital hydronephrosis. Int Urol Nephrol. 2015; 47(9):1457-61. DOI: 10.1007/s11255-015-1068-z. View

11.

Babu R, Venkatachalapathy E, Sai V . Hydronephrosis severity score: an objective assessment of hydronephrosis severity in children-a preliminary report. J Pediatr Urol. 2018; 15(1):68.e1-68.e6. DOI: 10.1016/j.jpurol.2018.09.020. View

12.

Mesrobian H, Mirza S . Hydronephrosis: a view from the inside. Pediatr Clin North Am. 2012; 59(4):839-51. DOI: 10.1016/j.pcl.2012.05.008. View

13.

Palmer L, Maizels M, Cartwright P, Fernbach S, Conway J . Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol. 1997; 159(1):222-8. DOI: 10.1016/s0022-5347(01)64072-2. View

14.

Vemulakonda V, Kempe A, Hamer M, Morris M . Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction. J Pediatr Surg. 2020; 56(3):620-625. PMC: 7606351. DOI: 10.1016/j.jpedsurg.2020.04.016. View

15.

Blum E, Porras A, Biggs E, Tabrizi P, Sussman R, Sprague B . Early Detection of Ureteropelvic Junction Obstruction Using Signal Analysis and Machine Learning: A Dynamic Solution to a Dynamic Problem. J Urol. 2017; 199(3):847-852. DOI: 10.1016/j.juro.2017.09.147. View

16.

Longpre M, Nguan A, MacNeily A, Afshar K . Prediction of the outcome of antenatally diagnosed hydronephrosis: a multivariable analysis. J Pediatr Urol. 2011; 8(2):135-9. DOI: 10.1016/j.jpurol.2011.05.013. View

17.

Hays S, Deshpande J . Newly postulated neurodevelopmental risks of pediatric anesthesia. Curr Neurol Neurosci Rep. 2011; 11(2):205-10. DOI: 10.1007/s11910-010-0177-4. View

18.

Gordon I, Piepsz A, Sixt R . Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging. 2011; 38(6):1175-88. DOI: 10.1007/s00259-011-1811-3. View

19.

Siemens D, Prouse K, MacNeily A, Sauerbrei E . Antenatal hydronephrosis: thresholds of renal pelvic diameter to predict insignificant postnatal pelviectasis. Tech Urol. 1999; 4(4):198-201. View

20.

Weitz M, Schmidt M, Laube G . Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol. 2016; 32(12):2203-2213. DOI: 10.1007/s00467-016-3566-3. View