Factors associated with surgical intervention in children with high-grade congenital hydronephrosis

Abstract

Purpose: A lack of uniform guidelines regarding ureteropelvic junction obstruction may be associated with demographic variations in pyeloplasty timing. This study objective was to determine if children who undergo surgery are more likely to be of minority race. Materials and methods: Children with Society for Fetal Urology (SFU) 3–4 hydronephrosis were reviewed. Demographic and clinical characteristics were abstracted. Bivariable associations between clinical/demographic characteristics and pyeloplasty versus observation as well as follow-up findings were assessed with chi-square testing. The bivariable relationship between race and time from first clinic visit to surgery was evaluated by Kaplan-Meier curve. Multivariable logistic regression was performed to estimate the relationship between clinical characteristics and management decision. Results: Thirty-nine patients underwent pyeloplasty and 50 were observed. There were no differences in demographics, including race/ethnicity. Factors associated with surgery included higher SFU grade ( p = 0.01), preoperative MAG3 ( p = 0.02), and T½ >20 ( p = 0.01). On multivariate analysis, MAG3 T½ >20 was associated with surgery (OR = 0.20, 95% CI: 0.07–0.61). Median time to surgery for whites versus non-whites was not significant (232 vs 208 days, p = 0.16). Conclusions: In our cohort, the decision to perform pyeloplasty is associated with clinical rather than demographic characteristics. Despite controversy regarding T½ interpretation, delayed radiotracer clearance remained a significant predictor of surgery.