The postnatal outcome and prognostic cut-off value of fetal pyelectasia / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: The purpose of our study was to evaluate the postnatal outcome of fetal pyelectasia and to assess the cut-off value for prediction of renal pathologic processes and surgical intervention. MATERIALS AND METHODS: Seventy-seven cases of pyelectasia were identified during the study period (1996 through 2000). Fetuses with antero-posterior pelvic diameter (APPD) >or=7 mm after 28 weeks were included. Postnatal evaluation included renal sonogram, voiding cystourethrogram, and renal flow and function studies. RESULTS: Renal pathologic processes after birth were found in 38 of 77 cases (49%). Ureteropelvic junction obstruction (19 cases, 50%) was the most common, followed by 4 cases of duplicated kidney, 3 cases of ureterovesical junction obstruction, 2 cases of primary vesicoureteral reflux, dysplastic kidney, extrarenal pelvis respectively and 1 case of ureterocele. Surgical intervention was performed in 21 cases (55%); pyeloplasty (13), nephrectomy (including partial) (3), transurethral incision of ureterocele (2), uretero- ureterostomy (1), uretero-cystostomy (2). Using cut-off value derived from receiver operating characteristic (ROC) curve, renal APPD >or=10.5 mm, >or=13.6 mm after 28 weeks gestation could predict the fetuses who would have renal pathologic processes and need surgical intervention, with sensitivity and specificity of 77.5%, 79.4% and 90.5%, 89.3%, respectively. CONCLUSION: It is possible to predict the fetuses who would require appropriate urologic evaluation and surgical intervention after birth, with determining the renal pelvic diameter in the third trimester of pregnancy.