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Multicenter Study
. 2021 Aug;53(8):1485-1495.
doi: 10.1007/s11255-021-02866-y. Epub 2021 May 4.

Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network

Vijaya M Vemulakonda  1   2 , Carter Sevick  3 , Elizabeth Juarez-Colunga  4 , George Chiang  5 , Nicolette Janzen  6 , Alison Saville  3 , Parker Adams  7 , Gemma Beltran  7 , Jordon King  6 , Emily Ewing  5 , Allison Kempe  3
Affiliations
Multicenter Study

Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network

Vijaya M Vemulakonda et al. Int Urol Nephrol. 2021 Aug.

Abstract

Purpose: Studies based on administrative databases show that infant pyeloplasty is associated with minority race/ethnicity but lack clinical data that may influence treatment. Our objective was to identify clinical and demographic factors associated with pyeloplasty in infants from three large tertiary centers.

Methods: We reviewed infants with unilateral Society for Fetal Urology (SFU) grade 3-4 hydronephrosis seen at three tertiary centers from 2/1/2018 to 9/30/2019. Patients were excluded if > 6 months old or treated surgically prior to the initial visit. Outcomes were: pyeloplasty < age 1 year and SFU grade on most recent ultrasound (US) within the first year. Covariables included: age at the initial visit, race/ethnicity, treating site, insurance type, febrile UTI, and initial imaging findings. Univariable and multivariable analyses were performed using log-rank tests and Cox proportional hazards models, respectively.

Results: 197 patients met study criteria; 19.3% underwent pyeloplasty. Pyeloplasty was associated with: treating site (p = 0.03), SFU 4 on initial US (p = 0.001), MAG-3 (p < 0.001), and T½ > 20 min (p < 0.001) in patients undergoing a MAG-3 (n = 107). MAG-3 (p < 0.001) and location (p = 0.08) were associated with earlier time to pyeloplasty on multivariable Cox analysis. In infants with follow-up US (n = 115), initial SFU grade, MAG-3 evaluation or findings, and pyeloplasty were not associated with improvement of hydronephrosis.

Conclusions: We found that infant pyeloplasty rates vary between sites. Prolonged T½ was associated with surgery despite prior studies suggesting this is a poor predictor of worsening dilation or function. These findings suggest the need to standardize evaluation and indications for intervention in infants with suspected UPJ obstruction.

Keywords: Electronic health record; Practice patterns; Prenatal hydronephrosis; Ureteropelvic junction obstruction.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest

Figures

Figure 1.
Figure 1.
Model of Time to Pyeloplasty by Evaluation with MAG3
Figure 2:
Figure 2:
Representative MAG-3 images (a) pre- and (b) post-pyeloplasty in an infant with SFU grade 4 hydronephrosis
Figure 2:
Figure 2:
Representative MAG-3 images (a) pre- and (b) post-pyeloplasty in an infant with SFU grade 4 hydronephrosis
Figure 3.
Figure 3.
Diagnostic Algorithm From: 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 [34]
See this image and copyright information in PMC

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