10 Years of Antenatal Hydronephrosis Experience: Comparing Two Different Guidelines

Abstract

Background Antenatal hydronephrosis refers to the dilation of the renal pelvis and/or calyces in the developing fetus. The challenge lies in distinguishing between cases that warrant long-term follow-up or surgical intervention and those with transient hydronephrosis that require minimal invasive investigations.

Materials and Methods Our study aimed to assess and contrast the efficacy of the 2015 Congenital Anomalies of Kidney and Urinary Tract Guideline from the Turkish Society of Pediatric Nephrology with the Tepecik Antenatal Hydronephrosis Guideline, which was previously employed in our hospital. We conducted a comparative analysis of demographic data, outcome conditions, additional imaging requirements and quantities, radiation exposures, and rates of surgical interventions between two groups.

Results Group 2 had a significantly higher detection rate of Vesicoureteral Reflux via voiding cystourethrogram at 38.5% compared to Group 1's 13.4% (p<0.01). The incidence of abnormal findings with dimercaptosuccinic acid was similar between Group 1 (28.5%) and Group 2 (26.4%) (p>0.01), but Group 2 had a higher rate of obstruction diagnosis at 68.8% versus Group 1's 29.4% (p<0.01). Group 1 had greater median radiation exposure (500 mrem vs. 200 mrem, p<0.01), and a higher proportion of patients underwent surgery (34.2% vs. 21.9%, p<0.01).

Conclusion This study showed that the new guideline required fewer tests, was less invasive, and exposed patients to less radiation than the old guideline.

Zusammenfassung

Hintergrund Unter einer pränatalen Hydronephrose versteht man eine Erweiterung des Nierenbeckens und/oder der Nierenkelche beim sich entwickelnden Feten. Die Unterscheidung zwischen Fällen, die eine langfristige Nachsorge oder eine operative Versorgung erfordern, und solchen mit vorübergehender Hydronephrose, bei denen eine minimalinvasive Diagnostik ausreicht, ist dabei nicht immer einfach.

Material und Methoden Ziel unserer Studie war es, die Effektivität der 2015 von der Türkischen Gesellschaft für Pädiatrische Nephrologie herausgegebenen Leitlinie zu angeborenen Fehlbildungen der Niere und der ableitenden Harnwege mit der der Tepecik-Leitlinie zur pränatalen Hydronephrose zu vergleichen, die früher in unserem Krankenhaus verwendet wurde. Dazu verglichen wir die demografischen Daten, die Outcome-Bedingungen, erforderliche zusätzliche Bildgebung und deren Häufigkeit, die Strahlenexposition und die Anzahl der operativen Eingriffe in den beiden Gruppen.

Ergebnisse In Gruppe 2 fand sich eine signifikant höhere Rate des Nachweises eines vesikoureteralen Refluxes mittels Miktionszystourethrographie im Vergleich zur Rate in Gruppe 1 (38,5 % vs. 13,4 %; p < 0,01). Hinsichtlich der Inzidenz von Auffälligkeiten in der DSMA-Szintigraphie waren beide Gruppe ähnlich (28,5 % in Gruppe 1:vs. 26, 4 % in Gruppe 2; p > 0,01); allerdings war die Rate diagnostizierter Obstruktionen in Gruppe 2 höher als in Gruppe 1 (68,8 % vs. 29,4 %; p < 0,01). In Gruppe 1 war die mediane Strahlenexposition und der Anteil der operierten Patienten höher als in Gruppe 2 (500 mrem vs. 200 mrem; p < 0,01 bzw. 34,2 % vs. 21,9 %; p < 0,01).

Schlussfolgerung Die vorliegende Studie konnte zeigen, dass die neue Leitlinie weniger Untersuchungen erforderte, weniger invasiv war und die Strahlenexposition der Patienten geringer war im Vergleich zur alten Leitlinie.

Keywords

Antenatal - hydronephrosis - voiding cystourethrography - dimercaptosuccinic acid

Schlüsselwörter

Pränatal - Hydronephrose - Miktionszystourethrographie - Dimercaptobernsteinsäure (DMSA)

Publication History

Article published online:
20 September 2024

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