Objectives: This study was performed to analyze the predictive factors of a contralateral operation after initial pyeloplasty in patients with antenatally detected bilateral ureteropelvic junction obstruction. Methods: Patients with prenatally diagnosed bilateral ureteropelvic junction obstruction who underwent initial pyeloplasty (aged <12 months at initial pyeloplasty) were offered to participate in the study. Patients were recruited from January 2012 to December 2015. The anteroposterior renal pelvic diameter, parenchymal thickness, and calyceal dilatation were evaluated. Predictive factors of contralateral pyeloplasty after initial unilateral pyeloplasty were also examined. Results: In total, 82 patients were included in the study (mean age, 2.8 months). Among all patients who underwent initial pyeloplasty, additional contralateral pyeloplasty was required in 11 patients (13.4%). The outcome of contralateral hydronephrosis was assessed as resolution, persistence, or surgery. The median anteroposterior renal pelvic diameter and calyceal dilatation were significantly different among the groups (p < 0.001). Calyceal dilatation of ≥10 mm and a calyceal dilatation/parenchymal thickness ratio of ≥5 strongly suggested the likelihood of a contralateral operation. Conclusions: In most patients with bilateral ureteropelvic junction obstruction, improvement or resolution of contralateral hydronephrosis following initial unilateral pyeloplasty can be expected. Patients with contralateral calyceal dilatation >10 mm and the calyceal dilatation/parenchymal thickness ratio >5 are at higher risk of surgery.

Journal Section:
Original Paper
Keywords:
Antenatal, Hydronephrosis, Ureteropelvic junction obstruction, Pyeloplasty
1.
Jiang D, Tang B, Xu M, Lin H, Jin L, He L, et al: Functional and morphological outcomes of pyeloplasty at different ages in prenatally diagnosed society of fetal urology grades 3–4 ureteropelvic junction obstruction: is it safe to wait? Urology 2017; 101: 45–49.
[PubMed]
https://doi.org/10.1016/j.urology.2016.10.004
2.
Kelley JC, White JT, Goetz JT, Romero E, Leslie JA, Prieto JC: Sonographic renal parenchymal measurements for the evaluation and management of ureteropelvic junction obstruction in children. Front Pediatr 2016; 4: 42.
[PubMed]
https://doi.org/10.3389/fped.2016.00042
3.
Menon P, Rao KL, Bhattacharya A, Mittal BR: Outcome analysis of pediatric pyeloplasty in units with less than 20% differential renal function. J Pediatr Urol 2016; 12: 171.e1–e7.
[PubMed]
https://doi.org/10.1016/j.jpurol.2015.12.013
4.
Arora S, Yadav P, Kumar M, Singh SK, Sureka SK, Mittal V, et al: Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction – a prospective multivariate analysis. J Pediatr Urol 2015; 11: 248.e1–e5.
[PubMed]
https://doi.org/10.1016/j.jpurol.2015.02.008
5.
Kim SO, Yu HS, Hwang IS, Hwang EC, Kang TW, Kwon D: Early pyeloplasty for recovery of parenchymal thickness in children with unilateral ureteropelvic junction obstruction. Urol Int 2014; 92: 473–476.
[PubMed]
https://doi.org/10.1159/000357144
6.
Lee YS, Jeong HJ, Im YJ, Kim MJ, Lee MJ, Yun M, et al: Factors indicating renal injury in pediatric bilateral ureteropelvic-junction obstruction. Urology 2013; 81: 873–878.
[PubMed]
https://doi.org/10.1016/j.urology.2012.09.064
7.
Kim J, Hong S, Park CH, Park H, Kim KS: Management of severe bilateral ureteropelvic junction obstruction in neonates with prenatally diagnosed bilateral hydronephrosis. Korean J Urol 2010; 51: 653–656.
[PubMed]
https://doi.org/10.4111/kju.2010.51.9.653
8.
Onen A, Jayanthi VR, Koff SA: Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol 2002; 168: 1118–1120.
[PubMed]
9.
Alconcher LF, Tombesi MM: Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed. Pediatr Nephrol 2012; 27: 1119–1123.
[PubMed]
https://doi.org/10.1007/s00467-012-2113-0
10.
Bajpai M, Chandrasekharam VV: Nonoperative management of neonatal moderate to severe bilateral hydronephrosis. J Urol 2002; 167: 662–665.
[PubMed]
https://doi.org/10.1097/00005392-200202000-00058
11.
Provet JA, Hanna MK: Simultaneous repair of bilateral ureteropelvic junction obstruction. Urology 1989; 33: 390–394.
[PubMed]
https://doi.org/10.1016/0090-4295(89)90032-0
12.
Dos Santos J, Parekh RS, Piscione TD, Hassouna T, Figueroa V, Gonima P, et al: A new grading system for the management of antenatal hydronephrosis. Clin J Am Soc Nephrol 2015; 10: 1783–1790.
[PubMed]
https://doi.org/10.2215/CJN.12861214
13.
Li XD, Wu YP, Wei Y, Chen SH, Zheng QS, Cai H, et al: Predictors of recoverability of renal function after pyeloplasty in adults with ureteropelvic junction obstruction. Urol Int 2018, Epub ahead of print.
[PubMed]
https://doi.org/10.1159/000486425
14.
Duong HP, Piepsz A, Khelif K, Collier F, de Man K, Damry N, et al: Transverse comparisons between ultrasound and radionuclide parameters in children with presumed antenatally detected pelvi-ureteric junction obstruction. Eur J Nucl Med Mol Imaging 2015; 42: 940–946.
[PubMed]
https://doi.org/10.1007/s00259-014-2965-6
15.
Babu R, Sai V: Pelvis/cortex ratio: an early marker of success following pyeloplasty in children. J Pediatr Urol 2010; 6: 473–476.
https://doi.org/10.1016/j.jpurol.2009.12.004
16.
Beland MD, Walle NL, Machan JT, Cronan JJ: Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol 2010; 195:W146–W149.
[PubMed]
https://doi.org/10.2214/AJR.09.4104
17.
Lødrup AB, Karstoft K, Dissing TH, Nyengaard JR, Pedersen M: The association between renal function and structural parameters: a pig study. BMC Nephrol 2008; 9: 18.
[PubMed]
https://doi.org/10.1186/1471-2369-9-18
18.
Dhillon HK: Prenatally diagnosed hydronephrosis: the great ormond street experience. Br J Urol 1998; 81: 39–44.
[PubMed]
https://doi.org/10.1046/j.1464-410X.1998.0810s2039.x
19.
Oktar T, Acar O, Atar A, Salabas E, Ander H, Ziylan O, et al: How does the presence of antenatally detected caliectasis predict the risk of postnatal surgical intervention? Urology 2012; 80: 203–206.
[PubMed]
https://doi.org/10.1016/j.urology.2012.01.083
20.
Imaji R, Dewan PA: Calyx to parenchyma ratio in pelvi-ureteric junction obstruction. BJU Int 2002; 89: 73–77.
[PubMed]
https://doi.org/10.1046/j.1464-410X.2002.02543.x
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