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Postnatal imaging of prenatally detected hydronephrosis—when is voiding cystourethrogram necessary?

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A Correction to this article was published on 15 June 2018

This article has been updated

Abstract

Objective

To evaluate whether grade 4–5 vesicoureteral reflux (VUR) can be predicted from renal ultrasound (RUS) findings and perform voiding cystourethrograms (VCUGs) only on high-risk patients.

Methods

The RUS and VCUG images of infants with prenatally detected hydronephrosis admitted to our institution between 2003 and 2013 were re-evaluated. The UTI episodes were collected retrospectively from patient journals. Patients with complex urinary tract anomalies were excluded.

Results

One hundred eighty, 44 female and 136 male, patients (352 renal units (RU)), 23 (30 RU) of them having grade 4–5 VUR, were included. The median age of the patients at the time of the RUS was 1.3 (0.1–3.0) months and the median follow-up time was 2.0 (0.1–11.2) years.

In multivariate analysis, a visible ureter (OR 12.72; CI 5.33–32.04, p < 0.001) and shorter renal length (OR 2.67; CR 1.50–4.86, p < 0.001) in RUS predicted grade 4–5 VUR while a visible ureter predicted UTIs (OR 5.75; CI 2.59–12.66, p < 0.001).

A three-grade risk score for high-grade VUR was developed based on the RUS findings and the patients were categorized into low-, intermediate-, and high-risk groups. The incidence of grade 4–5 VUR was 2.9% in the low-risk, 12.2% in the intermediate-risk, and 52.2% in the high-risk group. The sensitivity and specificity for detecting grade 4–5 VUR were 79 and 82%, respectively.

Conclusions

In patients with antenatally detected hydronephrosis, a visible ureter and reduced renal length in RUS are significant risk factors for high-grade VUR. A RUS-based risk scoring would probably reduce the proportion of unnecessary VCUGs.

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Change history

  • 15 June 2018

    The original publication contained an erroneous version of Table 3 with incorrect data regarding ureteral visibility. The authors apologize for any inconvenience caused by their mistake and are pleased to present the corrected table here.

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Acknowledgments

We would like to thank Mitja Lääperi, M.Sc., for the biostatistical expertise in our study.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Uppsala University children’s Hospital, Sjukhusvägen 85, 751 85, Uppsala, Sweden

    Sofia Visuri

  2. Department of Pediatric Nephrology and Transplantation, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland

    Timo Jahnukainen

  3. Department of Pediatric Radiology, Helsinki University Hospital, Helsinki, Finland

    Reetta Kivisaari

  4. Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland

    Sofia Visuri & Seppo Taskinen

Authors
  1. Sofia Visuri
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  2. Reetta Kivisaari
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  3. Timo Jahnukainen
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  4. Seppo Taskinen
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Corresponding author

Correspondence to Sofia Visuri.

Ethics declarations

The study protocol was approved by the ethics committee at Helsinki University Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.

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Visuri, S., Kivisaari, R., Jahnukainen, T. et al. Postnatal imaging of prenatally detected hydronephrosis—when is voiding cystourethrogram necessary?. Pediatr Nephrol 33, 1751–1757 (2018). https://doi.org/10.1007/s00467-018-3938-y

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  • DOI: https://doi.org/10.1007/s00467-018-3938-y

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