Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pediatric Urology, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
J Urol. 2020 Nov;204(5):1048-1053. doi: 10.1097/JU.0000000000001140. Epub 2020 May 18.
We aimed to compare the Society for Fetal Urology and anteroposterior pelvic diameter classification systems in predicting the time to resolution of isolated hydronephrosis.
We retrospectively reviewed isolated hydronephrosis cases prenatally detected and postnatally diagnosed between 1994 and 2018. Other urinary tract anomalies and vesicoureteral reflux were excluded. Baseline grades for both systems were collected. Anteroposterior pelvic diameter was classified as grade 1 to 4 over a scale of 5 mm. Resolution was defined by an anteroposterior pelvic diameter of less than 5 mm with Society for Fetal Urology grade I hydronephrosis. Time to resolution was analyzed using Kaplan-Meier curves.
The study population consisted of 831 patients (1,028 renal units). Median followup was 26 months (range 6 to 260), and 559 units (54.3%) reached resolution during a median followup of 9 months (1 to 133). Resolution rates at 48 months were 81.7%, 65.6%, 37.6% and 5.2% for Society for Fetal Urology grades I through IV disease and 80.0%, 41.2%, 13.1% and 2.5% for anteroposterior pelvic diameter grades 1 through 4, respectively. Discrepancies between these grades were present in 481 units (46.8%). Society for Fetal Urology grades II to IV categorized as anteroposterior pelvic diameter grade 1 showed a superior cumulative rate of resolution (84.7%) vs anteroposterior pelvic diameter grades 2 to 4 categorized as Society for Fetal Urology grade I (53.2%, log-rank test p <0.001).
Hydronephrosis cases with anteroposterior pelvic diameter grades 2 to 4 but categorized as Society for Fetal Urology grade I have an inferior cumulative rate of resolution than vice versa. Society for Fetal Urology grades have little influence on resolution when anteroposterior pelvic diameter is less than 10 mm. Therefore, anteroposterior pelvic diameter is more useful in predicting the time to resolution.
我们旨在比较胎儿泌尿外科学会（SFU）和前后径分类系统在预测单纯性肾积水消退时间方面的作用。
我们回顾性分析了 1994 年至 2018 年间产前诊断和产后确诊的单纯性肾积水病例。排除了其他尿路异常和膀胱输尿管反流。收集了两个系统的基线等级。前后径分为 5mm 为一个等级，共分为 1 到 4 级。SFU 分级为 I 级的肾积水，前后径小于 5mm 时定义为消退。使用 Kaplan-Meier 曲线分析消退时间。
研究人群包括 831 例患者（1028 个肾脏单位）。中位随访时间为 26 个月（6 至 260 个月），559 个肾脏单位（54.3%）在中位随访 9 个月（1 至 133 个月）时达到消退。SFU 分级为 I 至 IV 级的疾病在 48 个月时的消退率分别为 81.7%、65.6%、37.6%和 5.2%，前后径分级为 1 至 4 级的消退率分别为 80.0%、41.2%、13.1%和 2.5%。481 个肾脏单位（46.8%）的分级存在差异。SFU 分级 II 至 IV 级被归类为前后径分级 1 级的患者，其累积消退率明显高于被归类为 SFU 分级 I 级的前后径分级 2 至 4 级的患者（84.7%对 53.2%，log-rank 检验，p <0.001）。
前后径分级为 2 至 4 级但被归类为 SFU 分级 I 级的肾积水病例的累积消退率低于前后径分级为 1 级但被归类为 SFU 分级 II 至 IV 级的病例。当前后径小于 10mm 时，SFU 分级对消退的影响较小。因此，前后径在预测消退时间方面更有用。
