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PROGNOSTIC VALUE OF ULTRASOUND GRADING
SYSTEMS IN PRENATALLY DIAGNOSED UNILATERAL
URINARY TRACT DILATATION
Aurélien SCALABRE
1
, Delphine DEMEDE
1
, Segolene GAILLARD
2
,
Jean‑Pierre PRACROS
3
, Pierre MOURIQUAND
1
and Pierre-Yves MURE
4
1) Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Claude Bernard University Lyon 1, Chirurgie pédiatrique, Bron,
FRANCE - 2) EPICIME-Centre d’Investigation Clinique 1407 de Lyon, Inserm, CHU de Lyon, CNRS, UMR 5558, Bron,
FRANCE - 3) Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Claude Bernard University Lyon 1, Radiologie
Pediatrique, Bron, FRANCE - 4) Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Claude Bernard University
Lyon 1, Chirurgie Pediatrique, Bron, FRANCE
PURPOSE
To compare the prognostic values of the antero-posterior intrasinusal diameter (APD) of the renal
pelvis, Urinary Tract Dilation (UTD) and Society for Fetal Urology (SFU) grading systems in children
with prenatally diagnosed unilateral UTD.
MATERIAL AND METHODS
All newborns with prenatally diagnosed unilateral UTD, normal bladder andAPD ≥10 mm on the first
postnatal ultrasonography (US) were prospectively enrolled from January 2011 to February 2015.
Indications for surgery were: repeated febrile urinary tract infections and/or decrease of relative
renal function of more than 10% on serial isotope studies and/or increasing APD of more than 20%
on serial US scans. Sensitivity, specificity and ROC curves were calculated to evaluate the accuracy
of APD, UTD and SFU grading systems in discriminating children who would need surgery.
RESULTS
Seventy children (57 males and 13 females) were included. Thirty-three patients required surgery at
a median age of 5 months (2-41). The UTD remained stable in 14 cases and decreased in 23 cases
with a median follow-up of 42 months (25-67). APD, UTD and SFU scores were all correlated with
the need for surgery. APD with a threshold of 20 mm had the best prognostic value with a sensitivity
of 81.8% and a specificity of 91.7%.
CONCLUSIONS
Our study confirmed that the prognostic value of APD, UTD and SFU grading systems in newborns
with prenatally diagnosed unilateral UTD was comparable.APD and abnormal parenchymal thick-
ness are the most important US criteria to identify children at risk for surgery.