| Objective:The purpose of this study was to evaluate the prognostic prediction value of Society for Fetal Urology(SFU)and urinary tract dilatation(UTD)and discuss reliability of UTD grading system in follow-up and treatment by analyzing the follow-up data of children with ureteropelvic junction obstruction-like(UPJO-like)hydronephrosis(HN).Methods:Retrospective analysis was performed on ultrasound data of patients with fetal HN detected in Qingdao Women and Children’s Hospital from January 2017 to November2021.Patients were divided into groups according to pyeloplasty,urinary tract infection(UTI)and resolution conditions respectively.General information,data of urinary ultrasound(US)and age at occurrence of pyeloplasty,UTI and resolution were collected.All patients involved in the study were divided by SFU and UTD grading systems based on first US results after birth,and the value of two grading systems in predicting the clinical outcome of children with UPJO were then evaluated.Statistical methods including Chi-square test,Fisher exact test,log-rank test and receiver operating characteristic(ROC)curve were performed in this study.P<0.05 was considered statistically significant.Results:A total of 378 children with UPJO HN were included in this study,of which 107(28.0%)underwent pyeloplasty.10 of 213 patients considered as SFU I/II underwent pyeloplasty,while 97 of 165 patients in SFU III/IV underwent this surgery(4.7% vs58.8%,P<0.01).SFU grading system was statistically significant in predicting whether to perform pyeloplasty.Meanwhile,when UTD grading system was used,2 of 146 children in UTD P1 group and 105 of 232 children in UTD P2/3 group underwent pyeloplasty(1.4% vs 45.3%,P<0.01),meaning that UTD grading system was also statistically significant in predicting pyeloplasty.Among 12(3.0%)children who developed fever urinary tract infection(UTI)during follow-up,2(0.9%)belonged to SFU I/II group,while 10(6.1%)belonged to SFU III/IV group(P<0.01).No patients in UTD P1 group and 12 patients in UTD P2/3 group developed UTI(P<0.01).SFU and UTD grading systems had statistical significance in predicting UTI condition.Of 271 patients who did not undergo surgery,157 patients including 127 from SFU I/II group and 30 from SFU III/IV group underwent resolution(62.6% vs 44.1%,P<0.01).When grading by UTD system,93 of 144 children in UTD P1 group underwent spontaneous remission,while 64 in 127 patients from UTD P2/3 group experience resolution(64.6% vs 50.4%,P=0.018).SFU was statistically significant in predicting resolution situation while UTD system was not.Cumulative rate of pyeloplasty were 5.7% in SFU I/II group and 59.9% in SFU III/IV group(P<0.001),as well as 1.6% in UTD P1 group and 46.8% in UTD P2/3 group(P<0.001).Similarly,cumulative rate of UTI in SFU I/II and SFU III/IV was 1% and6.1% respectively(P<0.01).No patients with UTD P1 grade suffered UTI,comparing to5.3% in UTD P2/3 group(P<0.01).Patients in SFU I/II group had a resolution cumulative rate of 76.2% comparing 62.1% of SFU III/IV group(P=0.022).In UTD system,cumulative rate was 82.5% in UTD P1 group while 64.2% in UTD P2/3 group(P<0.01).Cumulative rates of pyeloplasty,UTI and resolution had statistical difference between different subgroups grading by SFU system.Similar results were observed in UTD system.Conclusion:1.Both SFU and UTD grading systems can probably grade the risk and predict the clinical outcomes of UPJO-like HN patients based on baseline US.2.Children with high grade HN(SFU Ⅲ/Ⅳ or UTD P2/P3)were more likely to undergo pyeloplasty,suffer from UTI and had less possibility of resolution.The opposite trend was observed on children with low grade HN.3.UTD grading system was effective in evaluating UPJOlike HN and could provide reliable reference for the follow-up and treatment of prenatal HN. |
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