Department of Urology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Urol. 2012 Nov;188(5):1935-9. doi: 10.1016/j.juro.2012.07.011. Epub 2012 Sep 20.
There are no current guidelines for diagnosing and managing mild prenatal hydronephrosis. Variations in physician approach make it difficult to analyze outcomes and establish optimal management. We determined the variability of diagnostic approach and management regarding prenatal hydronephrosis among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists.
Online surveys were sent to mailing lists for national societies for each specialty. Participants were surveyed regarding criteria for diagnosing mild prenatal hydronephrosis and recommendations for postnatal management, including use of antibiotic prophylaxis, followup scheduling and type of followup imaging.
A total of 308 maternal-fetal medicine obstetricians, 126 pediatric urologists and 112 pediatric radiologists responded. Pediatric urologists and radiologists were divided between Society for Fetal Urology criteria and use of anteroposterior pelvic diameter for diagnosis, while maternal-fetal medicine obstetricians preferred using the latter. For postnatal evaluation radiologists preferred using personal criteria, while urologists preferred using anteroposterior pelvic diameter or Society for Fetal Urology grading system. There was wide variation in the use of antibiotic prophylaxis among pediatric urologists. Regarding the use of voiding cystourethrography/radionuclide cystography in patients with prenatal hydronephrosis, neither urologists nor radiologists were consistent in their recommendations. Finally, there was no agreement on length of followup for mild prenatal hydronephrosis.
We observed a lack of uniformity regarding grading criteria in diagnosing hydronephrosis prenatally and postnatally among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. There was also a lack of agreement on the management of mild intermittent prenatal hydronephrosis, resulting in these cases being managed inconsistently. A unified set of guidelines for diagnosis, evaluation and management of mild intermittent prenatal hydronephrosis would allow more effective evaluation of outcomes.
目前尚无诊断和处理轻度产前肾积水的指南。由于医生处理方法的差异，使得分析结果和建立最佳处理方法变得困难。我们旨在确定母胎医学专家、小儿泌尿科医生和小儿放射科医生在处理产前肾积水方面诊断方法和管理的差异。
向每个专业的国家学会邮寄列表发送了在线调查。调查内容包括诊断轻度产前肾积水的标准和产后管理建议，包括使用抗生素预防、随访时间安排和随访影像学类型。
共有 308 名母胎医学专家、126 名小儿泌尿科医生和 112 名小儿放射科医生做出了回应。小儿泌尿科医生和放射科医生分为胎儿泌尿外科学会标准和使用前后骨盆直径进行诊断，而母胎医学专家更喜欢使用后者。对于产后评估，放射科医生更喜欢使用个人标准，而泌尿科医生更喜欢使用前后骨盆直径或胎儿泌尿外科学会分级系统。小儿泌尿科医生在使用抗生素预防方面存在广泛差异。对于产前肾积水患者使用排尿性膀胱尿道造影/放射性核素膀胱造影，泌尿科医生和放射科医生的建议均不一致。最后，对于轻度产前肾积水的随访时间长度也没有达成一致。
我们观察到，在母胎医学专家、小儿泌尿科医生和小儿放射科医生中，产前和产后诊断肾积水的分级标准不一致，并且在轻度间歇性产前肾积水的管理方面也没有达成一致，导致这些病例的处理不一致。一套统一的轻度间歇性产前肾积水的诊断、评估和管理指南将能够更有效地评估结果。
