Determination of the Need for Surgical Intervention in Infants Diagnosed with Fetal Hydronephrosis in China
Lei Zhang, Chao Liu, Yan Li, Chao Sun, Xiang Li
Department of Pediatric Surgery, Qilu Hospital of Shandong University, Ji’nan, Shandong, China (mainland)
Med Sci Monit 2016; 22:4210-4217
Hydronephrosis is a common congenital condition. The detection of fetal hydronephrosis by ultrasound presents a treatment dilemma. This study aims to examine postnatal follow-up and treatment for hydronephrosis diagnosed prenatally.
MATERIAL AND METHODS: This was a retrospective study of 210 infants with hydronephrosis diagnosed at the Qilu Hospital (Shangdong, China) between January 2005 and January 2013. The patient cohort was divided into four groups based on prenatal ultrasound examinations using the Society for Fetal Urology (SFU) classification system. Data on follow-up investigations and treatment methods were extracted from the charts and analyzed.
RESULTS: Patients with SFU grade 1, 2, and 3 hydronephrosis (n=125, n=74, and n=11, respectively) were followed for two years. In all, 2.4%, 18.9%, and 90.9% of patients with SFU grade 1, 2, and 3 hydronephrosis, respectively, underwent surgery. SFU grade 3 (HR=9.23, 95% CI: 1.43–59.74, p=0.02), APD (HR=2.81, 95% CI: 1.11–7.10, p=0.03), and parenchymal thickness (HR=0.42, 95% CI: 0.24–0.71, p=0.001) were independently associated with the occurrence of surgery. For anterioposterior diameter, using a cut-off point of 1.1, the area under the curve was 0.86, Youden index was 0.556, sensitivity was 70.4%, and specificity was 85.3%. For parenchymal thickness, using a cut-off point of 5, AUC was 0.79, Youden index was 0.478, sensitivity was 74.1%, and specificity was 73.8%.
CONCLUSIONS: Patients with SFU grade 2 hydronephrosis require long-term follow-up. Surgery and close postsurgical observation may be necessary for patients with SFU grade 3 and 4 hydronephrosis. An initial B-mode ultrasound screening at 7-10 days after birth may help make an optimal diagnosis and treatment selection.
Keywords: China, Hydronephrosis - surgery, Infant, Newborn, Kaplan-Meier Estimate, Multivariate Analysis, ROC Curve