Rickard Mandy, Lorenzo Armando J, Braga Luis H
Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada.
Division of Pediatric Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Ontario, Canada.
Urology. 2017 Mar;101:85-89. doi: 10.1016/j.urology.2016.09.029. Epub 2016 Oct 3.
To explore the potential value of an objective assessment, renal parenchyma to hydronephrosis area ratio (PHAR), as an early predictor of surgery.
Initial sagittal renal ultrasound (US) images of patients prospectively entered into a prenatal hydronephrosis database from January 2008 to January 2016 with baseline Society for Fetal Urology (SFU) grades III and IV prenatal hydronephrosis, without vesicoureteral reflux, were evaluated using the National Institutes of Health-sponsored image processing software. PHAR, anteroposterior diameter, SFU grade, and urinary tract dilation risk categories were contrasted with nuclear scan data (differential renal function and drainage time [t]) and analyzed for predictive value in determining the decision to proceed with surgery by drawing receiver operating characteristic curves.
Out of 196 infants (162 male; 138 left sided hydronephrosis), 58 (30%) underwent surgery to address obstruction. Surgical patients compared with those managed conservatively had longer t (60 vs 18 min; P < .01) and lower differential renal function (46 vs 50%; P = .01). Of the initial US parameters, PHAR (area under the curve = 0.816; P < .001) had a better predictive performance than anteroposterior diameter, SFU grade, or urinary tract dilation classification. PHAR values correlated with subsequent parameters obtained on nuclear scan.
PHAR is a promising parameter that can be estimated on presentation US to help predict future need for surgery in newborns with high-grade hydronephrosis.
探讨一种客观评估指标——肾实质与肾积水面积比（PHAR）作为手术早期预测指标的潜在价值。
使用美国国立卫生研究院赞助的图像处理软件，对2008年1月至2016年1月前瞻性纳入产前肾积水数据库的患者的初始矢状位肾脏超声（US）图像进行评估，这些患者基线胎儿泌尿外科学会（SFU）分级为III级和IV级产前肾积水，且无膀胱输尿管反流。将PHAR、前后径、SFU分级和尿路扩张风险类别与核素扫描数据（分肾功能和引流时间[t]）进行对比，并通过绘制受试者操作特征曲线分析其在确定是否进行手术决策中的预测价值。
在196例婴儿（162例男性；138例左侧肾积水）中，58例（30%）接受了手术以解决梗阻问题。与保守治疗的患者相比，接受手术的患者t更长（60 vs 18分钟；P <.01），分肾功能更低（46% vs 50%；P =.01）。在初始超声参数中，PHAR（曲线下面积 = 0.816；P <.001）的预测性能优于前后径、SFU分级或尿路扩张分类。PHAR值与核素扫描获得的后续参数相关。
PHAR是一个有前景的参数，可在初次超声检查时进行评估，以帮助预测重度肾积水新生儿未来的手术需求。
