Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network.
Int Urol Nephrol
; 53(8): 1485-1495, 2021 Aug.
Article
em En
| MEDLINE
| ID: mdl-33948809
ABSTRACT
PURPOSE:
Studies based on administrative databases show that infant pyeloplasty is associated with minority race/ethnicity but lack clinical data that may influence treatment. Our objective was to identify clinical and demographic factors associated with pyeloplasty in infants from three large tertiary centers.METHODS:
We reviewed infants with unilateral Society for Fetal Urology (SFU) grade 3-4 hydronephrosis seen at three tertiary centers from 2/1/2018 to 9/30/2019. Patients were excluded if > 6 months old or treated surgically prior to the initial visit. Outcomes were pyeloplasty < age 1 year and SFU grade on most recent ultrasound (US) within the first year. Covariables included age at the initial visit, race/ethnicity, treating site, insurance type, febrile UTI, and initial imaging findings. Univariable and multivariable analyses were performed using log-rank tests and Cox proportional hazards models, respectively.RESULTS:
197 patients met study criteria; 19.3% underwent pyeloplasty. Pyeloplasty was associated with treating site (p = 0.03), SFU 4 on initial US (p = 0.001), MAG-3 (p < 0.001), and T½ > 20 min (p < 0.001) in patients undergoing a MAG-3 (n = 107). MAG-3 (p < 0.001) and location (p = 0.08) were associated with earlier time to pyeloplasty on multivariable Cox analysis. In infants with follow-up US (n = 115), initial SFU grade, MAG-3 evaluation or findings, and pyeloplasty were not associated with improvement of hydronephrosis.CONCLUSIONS:
We found that infant pyeloplasty rates vary between sites. Prolonged T½ was associated with surgery despite prior studies suggesting this is a poor predictor of worsening dilation or function. These findings suggest the need to standardize evaluation and indications for intervention in infants with suspected UPJ obstruction.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Obstrução Ureteral
/
Pelve Renal
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
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Etiology_studies
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Prognostic_studies
Limite:
Humans
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Infant
Idioma:
En
Revista:
Int Urol Nephrol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Estados Unidos