Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
Pediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria.
Ultraschall Med. 2020 Jun;41(3):278-285. doi: 10.1055/a-0591-3303. Epub 2018 Jul 5.
Parents confronted with the finding of antenatal hydronephrosis (ANH) are particularly interested in whether their baby will need postnatal surgery. The objective of this study was to predict ANH requiring surgery on the basis of the fetal anteroposterior renal pelvic diameter (APRPD) and the Society for Fetal Urology (SFU) grading system.
The medical records of 179 patients with the finding of ANH were reviewed retrospectively. ANH was graded according to the SFU grading system. Prenatal ultrasound examinations were correlated to postnatal outcome, which was divided into three groups: prenatal resolution, conservative management and surgical treatment.
58 (32.4 %) cases were classified as prenatal resolution, 89 (49.7 %) babies were assigned to the conservative outcome group and 32 (17.9 %) patients needed surgical repair. Postnatal surgery was best predicted in the second trimester (area under the receiver operating characteristics curve: 0.839) by an APRPD cut-off of 8.3 mm (sensitivity: 77.8 %; specificity: 85.7 %; PPV of 53.9 %, NPV of 94.7 %). The combination of the parameters "progression of SFU grade" and SFU grade 3 or 4 achieved a sensitivity of 84.4 % and a specificity of 80.3 % for the prediction of surgery.
Second-trimester APRPD is a useful parameter for predicting the risk for postnatal surgery. The SFU grade should be assessed in every prenatal ultrasound examination as some further risk estimates can be made based on its dynamics over time.
面对产前肾积水（ANH）的发现，父母特别关注他们的宝宝是否需要产后手术。本研究的目的是基于胎儿前后肾盂直径（APRPD）和胎儿泌尿外科学会（SFU）分级系统预测需要手术的 ANH。
回顾性分析了 179 例 ANH 患者的病历。根据 SFU 分级系统对 ANH 进行分级。将产前超声检查与产后结果相关联，产后结果分为三组：产前缓解、保守治疗和手术治疗。
58 例（32.4%）病例被归类为产前缓解，89 例（49.7%）婴儿被分配到保守治疗组，32 例（17.9%）患者需要手术修复。在第二个三个月（受试者工作特征曲线下面积：0.839），8.3mm 的 APRPD 临界值（灵敏度：77.8%；特异性：85.7%；PPV 为 53.9%，NPV 为 94.7%）对预测产后手术最有效。参数“SFU 分级进展”和 SFU 分级 3 或 4 的组合对手术的预测具有 84.4%的灵敏度和 80.3%的特异性。
第二个三个月的 APRPD 是预测产后手术风险的有用参数。SFU 分级应在每次产前超声检查中进行评估，因为可以根据其随时间的动态变化做出一些进一步的风险估计。
