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Imaging in children with unilateral ureteropelvic junction obstruction: time to reduce investigations?

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Abstract

The objective of the study was the development of an abridged risk-stratified imaging algorithm for the management of children with unilateral ureteropelvic junction obstruction (UPJO). Data on timing, frequency and duration of diagnostic imaging in children with unilateral UPJO was extracted retrospectively. Based on these findings, an abridged imaging algorithm was developed without changing the intended management by the clinicians and the outcome of the individual patient. The potential reduction of imaging studies was analysed and stratified by risk and management groups. The reduction in imaging studies, seen for ultrasound (US) and functional imaging (FI), was 45% each. On average, this is equivalent to 3 US and 1 FI studies less for every patient within the study period. The change was more pronounced in the low-risk groups. Progression of UPJO never occurred after 2 years of age and all secondary surgeries were carried out until the age of 3.

Conclusions: Although our findings need to be validated by further prospective research, the developed imaging algorithm represents a risk-stratified approach towards less imaging studies in children with unilateral UPJO, and a follow-up beyond 3 years of age should be considered only in selected cases at the discretion of the clinician.

What is Known:

• ultrasound and functional imaging represent an integral part of therapeutic decision-making in children with unilateral ureteropelvic junction obstruction

• imaging studies cannot accurately assess which patients are in need of surgical intervention, therefore close, serial imaging is preferred

What is New:

• a new, risk-stratified imaging algorithm was developed for the first 3 years of life

• applying this algorithm could lead to a considerable reduction of imaging studies, and also the associated risks and health-care costs

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Abbreviations

APRPD:

anterior-posterior renal pelvis diameter

FI:

functional imaging

MRU:

magnet resonance urography

RS:

renal scintigraphy

SRF:

split renal function

UPJO:

unilateral ureteropelvic junction obstruction

US:

ultrasound

VCUG:

voiding cystourethrogram

VUR:

vesicoureteral reflux

References

  1. Caiulo VA, Caiulo S, Gargasole C, Chiriaco G, Latini G, Cataldi L, Mele G (2012) Ultrasound mass screening for congenital anomalies of the kidney and urinary tract. Pediatr Nephrol 27(6):949–953. doi:10.1007/s00467-011-2098-0

    Article  PubMed  Google Scholar 

  2. Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, Cooper C, Crino J, Darge K, Herndon CD, Odibo AO, Somers MJ, Stein DR (2014) Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 10(6):982–998. doi:10.1016/j.jpurol.2014.10.002

    Article  PubMed  Google Scholar 

  3. Piepsz A (2011) Antenatal detection of Pelviureteric junction stenosis: main controversies. Semin Nucl Med 41(1):11–19. doi:10.1053/j.semnuclmed.2010.07.008

    Article  PubMed  Google Scholar 

  4. Beetz R, Bokenkamp A, Brandis M, Hoyer P, John U, Kemper MJ, Kirschstein M, Kuwertz-Broking E, Misselwitz J, Muller-Wiefel DE, Rascher W (2001) Diagnosis of congenital dilatation of the urinary tract. Consensus Group of the Pediatric Nephrology Working Society in cooperation with the pediatric urology working Group of the German Society of urology and with the pediatric urology working Society in the Germany Society of pediatric surgery. Urologe A 40(6):495–507 quiz 508-499

    Article  CAS  PubMed  Google Scholar 

  5. McCann ME, Soriano SG (2012) General anesthetics in pediatric anesthesia: influences on the developing brain. Curr Drug Targets 13(7):944–951

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fazel R, Krumholz HM, Wang YF, Ross JS, Chen J, Ting HH, Shah ND, Nasir K, Einstein AJ, Nallamothu BK (2009) Exposure to low-dose ionizing radiation from medical imaging procedures. New Engl J Med 361(9):849–857. doi:10.1056/NEJMoa0901249

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tekgül S, Dogan HS, Hoebeke P, Kocvara R, Nijman JM, Radmayr C, Stein R, Erdem E, Nambiar AK, Silay MS, Undre S (2016) Guidelines on paediatric urology, available at http://Uroweb.Org/Guideline/Paediatric-urology/. European Association of Urology

  8. Conway JJ, Maizels M (1992) The "well tempered" diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. A report from combined meetings of the Society for Fetal Urology and members of the pediatric nuclear medicine council--the Society of Nuclear Medicine. J Nucl Med 33(11):2047–2051

    CAS  PubMed  Google Scholar 

  9. Jones RA, Perez-Brayfield MR, Kirsch AJ, Grattan-Smith JD (2004) Renal transit time with MR urography in children. Radiology 233(1):41–50. doi:10.1148/radiol.2331031117

    Article  PubMed  Google Scholar 

  10. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, Lee R, Perez-Brayfield M, Metcalfe P, Yerkes E, Cendron M, Campbell JB (2010) The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 6(3):212–231. doi:10.1016/j.jpurol.2010.02.205

    Article  PubMed  Google Scholar 

  11. Perez-Brayfield MR, Kirsch AJ, Jones RA, Grattan-Smith JD (2003) A prospective study comparing ultrasound, nuclear scintigraphy and dynamic contrast enhanced magnetic resonance imaging in the evaluation of hydronephrosis. J Urol 170(4 Pt 1):1330–1334. doi:10.1097/01.ju.0000086775.66329.00

    Article  PubMed  Google Scholar 

  12. Sidhu G, Beyene J, Rosenblum ND (2006) Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis. Pediatr Nephrol 21(2):218–224. doi:10.1007/s00467-005-2100-9

    Article  PubMed  Google Scholar 

  13. Gordon I, Dhillon HK, Peters AM (1991) Antenatal diagnosis of renal pelvic dilatation--the natural history of conservative management. Pediatr Radiol 21(4):272–273

    Article  CAS  PubMed  Google Scholar 

  14. Weitz M, Schmidt M, Laube G (2016) Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol. doi:10.1007/s00467-016-3566-3

  15. Furlow B (2011) Radiation protection in pediatric imaging. Radiol Technol 82(5):421–439

    PubMed  Google Scholar 

  16. ICRP (2013) Radiological protection in paediatric diagnostic and interventional radiology. ICRP publication 121. Ann ICRP 42 (2)

  17. Akhavan A, Shnorhavorian M, Garrison LP Jr, Merguerian PA (2014) Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants. J Urol 192(3):919–924. doi:10.1016/j.juro.2014.03.110

    Article  PubMed  Google Scholar 

  18. Weitz M, Schmidt M (2016) To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review. Eur J Pediatr. doi:10.1007/s00431-016-2818-3

  19. Riccabona M, Avni FE, Blickman JG, Dacher JN, Darge K, Lobo ML, Willi U (2008) 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 38(2):138–145. doi:10.1007/s00247-007-0695-7

    Article  PubMed  Google Scholar 

  20. Dias CS, Silva JM, Pereira AK, Marino VS, Silva LA, Coelho AM, Costa FP, Quirino IG, Simoes ESAC, Oliveira EA (2013) Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol 190(2):661–666. doi:10.1016/j.juro.2013.02.014

    Article  PubMed  Google Scholar 

  21. Subramaniam R, Kouriefs C, Dickson AP (1999) Antenatally detected pelvi-ureteric junction obstruction: concerns about conservative management. BJU Int 84(3):335–338

    Article  CAS  PubMed  Google Scholar 

  22. Hacker HW, Szavay P, Dittmann H, Haber HP, Fuchs J (2009) Pyeloplasty in children: is there a difference in patients with or without crossing lower pole vessel? Pediatr Surg Int 25(7):607–611. doi:10.1007/s00383-009-2385-z

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Nadin Abadir, Maria Schmidt, Guido F. Laube & Marcus Weitz

  2. University Children’s Hospital Tuebingen, Tuebingen, Germany

    Marcus Weitz

Authors
  1. Nadin Abadir
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  2. Maria Schmidt
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  3. Guido F. Laube
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  4. Marcus Weitz
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Contributions

Maria Schmidt and Nadin Abadir participated in extraction and analysis of the data, and in writing of the article. Marcus Weitz participated in the design of the work, analysis and interpretation of the data and writing of the article. Guido Laube provided general advice on the manuscript and participated in writing of the article. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Marcus Weitz.

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No funding was received.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics commissions.

Additional information

Communicated by Mario Bianchetti

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Abadir, N., Schmidt, M., Laube, G.F. et al. Imaging in children with unilateral ureteropelvic junction obstruction: time to reduce investigations?. Eur J Pediatr 176, 1173–1179 (2017). https://doi.org/10.1007/s00431-017-2966-0

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  • DOI: https://doi.org/10.1007/s00431-017-2966-0

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