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S8-13
(P)
PREDICTION OF FAILURE OF CONSERVATIVE MANAGEMENT IN ANTENATALLY
DETECTED HYDRONEPHROSIS: APROSPECIVE STUDY
M S ANSARI
1
and Sohrab AROARA
2
1) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Urology and renal transplantation,
Lucknow, INDIA - 2) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Luckonw, INDIA
PURPOSE
Authors try to find parameters to predict which patients of antenatally detected hydronephrosis (ANH) due to
ureteropelvic junction obstruction (UPJO) will eventually need surgery during conservative management.
MATERIAL AND METHODS
Prospectively data were collected by single surgeon at single centre over 10 years involving 150 renal units. Patients on
conservative management were followed using a standard protocol. Patients who underwent surgery were compared
with the non-operated group in terms of sex, side, grade of hydronephrosis, maximum anterioposterior diameter (APD),
cortical thickness (CT) on first ultrasound and differential renal function (DRF) on first renal scan.
RESULTS
Of the 135 renal units qualified for conservative management, 42.2% had SFU grade IV hydronephrosis. Mean APD and
mean CT on first ultrasound were 18.6±8.6 and 7.5±3.2 mm respectively. Median time to failure of conservative
management was 37 weeks. Univariate analysis revealed that SFU grade, APD, CT, and preoperative DRF had
significant association with surgery (p <0.05). Multivariate analysis revealed APD and preoperative DRF as the only
independent predictors for need of surgery. Receiver operating curve analysis showed that APD of 24.3mm can predict
the need for surgery with a sensitivity of 73.1% and a specificity of 88%.
CONCLUSIONS
APD and DRF are the predictive factors for need of surgery in ANH during conservative treatment. We can reduce the
burden of investigations in those with APD <24 mm.