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19–22 APRIL, 2017, BARCELONA, SPAIN
14:51–14:54
S17-3 (PP)
EFFICACY OF UPPER TRACT DILATATION CLASSIFICATION
IN PREDICTING THE NEED FOR PYELOPLASTY COMPARED
TO THE CURRENT UK APPROACH
Mohammad BADER, Hariom SUR, Andrew ROBB, Harish CHANDRAN
and Liam MCCARTHY
Birmingham Children’s Hospital, Paediatric Urolgoy, Birmingham, UNITED KINGDOM
PURPOSE
UK functional diagnostic approach (Renal functions and anteroposterior diameter (APD)) for py-
eloplasties is different from USA morphological approach (Society for Fetal Urology classification).
Recent Upper Tract dilatation (UTD) classification has unified antenatal and post-natal grading. We
aimed to test the efficacy of this grading scheme to our functional approach to predict the need for
pyeloplasty in UK children.
MATERIAL AND METHODS
A retrospective case-control study was performed by identifying pyeloplasty patients with isolated
PUJO, and controls from MAG3 studies. The demographics, radiological findings and UTD score
were analysed. Children with abnormal ureters and bladders were excluded.
Data given as median (inter-quartile range). Fisher exact test was used to compare contingency
tables, Mann-Whitney u-test for cardinal data (p<0.05 significant). Odds ratios were calculated for
each predictive factor.
RESULTS
50 patients were identified in each group. There was no significant difference between operative
group age at operation 1.00(0.55-6.25) years vs. non-operative controls age at scan 2.87(1.55-
9.52) years (p=0.23). APD was significantly higher in the pyeloplasty group, 26.5(19-31)mm vs.
11(8-16)mm, p<0.0001. MAG3 differential function was lower in the pyeloplasty group, 44(38-51)%
vs 49(44-53)%, p<0.05.
When UTD3 criteria was compared with UK diagnostic factors (APD >20mm and rising, APD
>30mm or combination), all were statistically significantly (p<0.0001) associated with pyeloplasty
not surprisingly, however UTD grade 3 was most sensitive (94%) and 2
nd
most specific (98%). APD
>30mm, Rising APD >20mm and function <40% were very specific but less sensitive but in combi-
nation sensitivity was 74% and specificity was 86%.
CONCLUSIONS
UTD grade 3 correlates extremely well with the need for pyeloplasty by UK criteria. The use of UTD
classification is extremely efficacious, and suggests prospective trials should be done. Furthermore,
standardization of this classification will allow international comparisons of practice to be made.