Predictors of surgical intervention for antenatally detected ureteropelvic junction obstruction (UPJO): A prospective multivariate analysis

Abstract

Objective: We aimed to identify clinical and radiological predictors of the need for surgical intervention in infants with antenatally detected UPJO. Material and methods: We prospectively followed infants born with antenatally diagnosed ureteropelvic junction obstruction (UPJO) presented at our outpatient clinics for evidence of obstructive injury with a standard protocol with ultrasonography and renal scintigraphy. Indications for surgery included progression of hydronephrosis on serial examinations, initial differential renal function (DFR) ⩽35% or >5% loss in sequential studies, and febrile urinary tract infection (UTI). Univariate and multivariate analyses were utilized to define the predictors for surgical intervention, while the appropriate cut-off value of the initial Anteroposterior diameter (APD) was determined using the receiver operator curve analysis. Results: Univariate analysis revealed a significant association between surgery, the initial APD, cortical thickness, Society for Fetal Urology grade, UTD risk group, initial DRF, and febrile UTI ( p-value < 0.05). No significant association between surgery and sex or side of the affected kidney ( p-value 0.91 and 0.38, respectively). On multivariate analysis, the initial APD, initial DRF, obstructed renographic curve, and febrile UTI ( p-value < 0.05) were the only independent predictors for surgical intervention. An initial APD of 23 mm can predict surgical requirement, with a specificity of 95% and sensitivity of 70%. Conclusion: For antenatally diagnosed UPJO, the APD value (at the age of 1 week), DFR value (at the age of 6–8 weeks), and febrile UTI during follow-up are significant and independent predictors of the need for surgical intervention. APD, when used with a cut-off value of 23 mm, is associated with high specificity and sensitivity for predicting surgical need.