ESPU Congress 2018 - Abstract Book

CONGRESS OF THE ESPU

S5: VESICOURETERAL REFLUX 2

Moderators: Goedele Beckers (Netherlands), Alexander Springer (Austria)

ESPU Meeting on Thursday 12, April 2018, 08:52–09:34

08:52–08:55

S5-1 (PP)

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POSTNATAL IMAGING OF PRENATALLY

DETECTED HYRONEPHROSIS – WHEN IS VOIDING

CYSTOURETHROGRAM NECESSARY?

Sofia VISURI

, Reetta KIVISAARI

, Timo JAHNUKAINEN

and Seppo TASKINEN

1) Helsinki University Hospital, Department of Pediatric surgery, Helsinki, FINLAND - 2) Helsinki University Hospital,

Department of Pediatric Radiology, Helsinki, FINLAND - 3) Helsinki University Hospital, Department of Pediatric

Nephrology and Transplantation, Helsinki, FINLAND

PURPOSE

To evaluate whether grade 4–5 vesicoureteral reflux (VUR) and increased risk for UTI can be

predicted from renal ultrasound (RUS) findings and perform voiding cystourethrograms (VCUGs)

only on high-risk patients.

MATERIAL AND METHODS

After ethical approval RUS and VCUG images of infants with prenatally detected hydronephrosis

(HN) admitted to our institution between the years 2003–2013 were re-evaluated. The UTI epi-

sodes were collected retrospectively from the patient journals. Patients with complex urinary tract

anomalies were excluded.

RESULTS

One-hundred-eighty patients (352 renal units (RU)), 23 (30 RU) of them having grade 4–5 VUR

were included. The median age of the patients at the time of the RUS was 1.3 (0.1–3.0) months and

the median follow up-time was 2.0 (0.1–11.2) years.

In multivariate analysis, a visible ureter (OR 12.72; CI 5.33–32.04, p<0.001) and shorter renal

length (OR 2.67; CR 1.50–4.86, p<0.001) in RUS predicted grade 4–5 VUR while a visible ureter

predicted UTI (OR 5.93; CI 2.83–12.30, p<0.001).

A three-grade risk score was developed based on the RUS findings and the patients were catego-

rized into low-, intermediate- and high-risk groups. The incidence of grade 4–5 VUR was 2.9 % in

the low-risk, 12.2 % in the intermediate-risk and 52.2 % in the high-risk groups. The sensitivity for

detecting grade 4–5 VUR was 79 % and the specificity 82 % respectively.

CONCLUSIONS

A visible ureter and reduced renal length in RUS are significant risk factors for high-grade VUR. Our

results suggest that by using RUS based risk scoring a significant portion of unnecessary VCUGs

can be avoided.