Rickard Mandy, Lorenzo Armando J, Braga Luis H, Munoz Caroline
Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada.
Division of Pediatric Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Canada.
Urology. 2017 Jun;104:166-171. doi: 10.1016/j.urology.2017.01.015. Epub 2017 Jan 19.
To explore the value of renal parenchyma-to-hydronephrosis area ratio (PHAR) in detecting trends of hydronephrosis (HN) improvement or worsening and response to surgical intervention.
Initial and follow-up sagittal renal ultrasound images of patients entered into a prenatal HN database from 2008 to 2016, with baseline Society for Fetal Urology (SFU) grades III and IV HN and without vesicoureteral reflux, were evaluated using National Institutes of Health-sponsored image-processing software. Renal parenchymal area, hydronephrosis area (HA), PHAR, anteroposterior diameter (APd), and SFU grade were captured at baseline and most recent visit. Data were analyzed based on the need for surgical intervention to address obstruction.
Out of 193 infants (159 boys; 135 left side), 58 (30%) underwent surgery. Patients managed surgically compared with those managed nonsurgically had worse baseline HN severity markers: SFU grade (3.6 ± 0.5 vs 3.1 ± 0.4; P <.001), urinary tract dilation classification (2.7 ± 0.5 vs 2.2 ± 0.4; P <.001), APd (20.3 ± 10.1 vs 12.8 ± 8.0; P <.001), HA (10.0 ± 6.6 vs 4.7 ± 2.8; P <.001), and PHAR (1.3 ± 1.0 vs 3.0 ± 2.9; P <.001); but both patient groups had similar renal parenchymal area (9.4 ± 3.5 vs 9.7 ± 2.8; P = .5). At last follow-up, the following discrepancies persisted: SFU grade (2.3 ± 1.0 vs 1.7 ± 1.0; P <.001), urinary tract dilation classification (1.5 ± 0.7 vs 1.0 ± 0.7; P <.001), APd (11.7 ± 8.0 vs 7.7 ± 5.7; P <.001), and HA (6.4 ± 5.1 vs 3.6 ± 2.7; P <.001); however, PHAR was equalized for both groups (7.2 ± 14.0 vs 7.1 ± 6.1; P = .9).
By concurrently considering changes in renal parenchyma and degree of HN, we found that PHAR appears to be a promising parameter that reflects similarities between patients managed surgically and those managed nonsurgically, despite initial discrepancies. Our data suggest that this variable may provide reassurance and a more objective assessment of improvement after surgery compared with other traditional ultrasound outcome measures.
探讨肾实质与肾积水面积比值（PHAR）在检测肾积水（HN）改善或恶化趋势以及对手术干预反应方面的价值。
使用美国国立卫生研究院资助的图像处理软件，对2008年至2016年纳入产前HN数据库的患者的初始和随访肾脏矢状位超声图像进行评估，这些患者基线时胎儿泌尿外科学会（SFU）分级为III级和IV级HN且无膀胱输尿管反流。在基线和最近一次随访时记录肾实质面积、肾积水面积（HA）、PHAR、前后径（APd）和SFU分级。根据是否需要手术干预解除梗阻对数据进行分析。
193例婴儿（159例男孩；135例左侧）中，58例（30%）接受了手术。与非手术治疗的患者相比，接受手术治疗的患者基线时HN严重程度指标更差：SFU分级（3.6±0.5对3.1±0.4；P<.001）、尿路扩张分类（2.7±0.5对2.2±0.4；P<.001）、APd（20.3±10.1对12.8±8.0；P<.001）、HA（10.0±6.6对4.7±2.8；P<.001）和PHAR（1.3±1.0对3.0±2.9；P<.001）；但两组患者的肾实质面积相似（9.4±3.5对9.7±2.8；P = 0.5）。在最后一次随访时，以下差异仍然存在：SFU分级（2.3±1.0对1.7±1.0；P<.001）、尿路扩张分类（1.5±0.7对1.0±0.7；P<.001）、APd（11.7±8.0对7.7±5.7；P<.001）和HA（6.4±5.1对3.6±2.7；P<.001）；然而，两组的PHAR已趋同（7.2±14.0对7.1±6.1；P = 0.9）。
通过同时考虑肾实质的变化和HN的程度，我们发现PHAR似乎是一个有前景的参数，尽管初始存在差异，但它能反映手术治疗和非手术治疗患者之间的相似性。我们的数据表明，与其他传统超声结果测量指标相比，这个变量可能为术后改善情况提供更可靠且更客观的评估。
