Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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

References

    1. Mesrobian HG, Mirza SP. Hydronephrosis: a view from the inside. Pediatr Clin North Am 2012. August; 59(4): 839–51. - PubMed
    1. Siemens DR, Prouse KA, MacNeily AE, Sauerbrei EE. Antenatal hydronephrosis: threshholds of renal pelvic diameter to predict insignificant postnatal pelvicaliectasis. Tech Urol 1998; 4(4): 198–201. - PubMed
    1. Fefer S, Ellsworth P. Prenatal hydronephrosis. Pediatr Clin North Am 2006; 53:429–47. - PubMed
    1. Riccabona M, Avni FE, Blickman JG, Dcher JN, Darge K, Lobo ML, Willi U. Imaging recommendations in paediatric uroradiology. Minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR Annual Congress, Edinburgh, UK, June 2008.Pediatr Radiol; 2009. August; 39(8): 891–8. - PubMed
    1. Weitz M, Portz S, Laube GF, Meerpohl JJ, Bassler D. Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age. Cochrane Database Syst Rev 2016. July 14; 7 CD010716. - PMC - PubMed

Publication types