Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

S5-10

(P)

UROEPITHELIAL THICKENING IMPROVES DETECTION OF VESICOURETERAL

REFLUX IN INFANTS WITH PRENATAL HYDRONEPHROSIS

Daryl MCLEOD

, Gregory BATES

, Brian BECKNELL

, Christina CHING

, Daniel HERZ

, Seth ALPERT

and Zachary

GORDON

1) Nationwide Children's Hospital, Pediatric Urology, Columbus, USA - 2) Nationwide Children's Hospital, Pediatric

Radiology, Columbus, USA - 3) Nationwide Children's Hospital, Pediatric Nephrology, Columbus, USA - 4) The Ohio State

University, Urology, Columbus, USA

PURPOSE

Uroepithelial thickening (UET) of the renal pelvis is a sonographic finding associated with inflammation, prior distention,

or vesicoureteral reflux (VUR); however, the significance of this finding in association with prenatal hydronephrosis

(PNH) is unknown. We sought to determine if the presence of UET on renal ultrasound (RUS) improves the ability of this

study to detect VUR in infants with PNH.

MATERIAL AND METHODS

Between 2003-2013, we identified 135 infants (< 30 days old) with postnatal RUS to evaluate PNH and who also had

voiding cystourethrogram (VCUG) within 90 days. Patients with neurogenic bladder, posterior urethral valve or urinary

tract infection were excluded. A pediatric radiologist and urologist reviewed all imaging. Two criteria indicating a

“positive” RUS were compared; 1) Society for Fetal Urology (SFU) grade 3-4 hydronephrosis or 2) at least two of the

following: UET, hydroureter, collecting system duplication or renal dysmorphia. Sensitivity, specificity, positive predictive

value (PPV), negative predictive value (NPV) of RUS for any VUR and high grade VUR (HGVUR) were calculated.

RESULTS

For predicting any VUR, criteria 2 showed similar sensitivity (54% vs. 54%), but improved specificity (82% vs. 49%),

PPV (55% vs. 30%) and NPV (81% vs. 72%). For predicting HGVUR, criteria 2 showed higher sensitivity (100% vs.

75%), specificity (82% vs. 51%), PPV (42% vs. 17%), and NPV (100% vs. 94%).

CONCLUSIONS

By using criteria 2 which includes UET for infants with PNH, prediction of VUR was improved and 22 of 135 (16%)

VCUGs could have been safely omitted without missing any HGVUR; this may enhance patient care by decreasing

radiation exposure, family anxiety and health care costs.