Vijaya M Vemulakonda1,2, Carter Sevick3, Elizabeth Juarez-Colunga4, George Chiang5, Nicolette Janzen6, Alison Saville3, Parker Adams7, Gemma Beltran7, Jordon King6, Emily Ewing5, Allison Kempe3. 1. Pediatric Urology Research Enterprise, Department of Pediatric Urology, Division of Urology, Department of Surgery, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, 13123 East 16th Avenue, Mailbox B-463, Aurora, CO, 80045, USA. Vijaya.Vemulakonda@childrenscolorado.org. 2. Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA. Vijaya.Vemulakonda@childrenscolorado.org. 3. Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA. 4. Department of Biostatistics and Informatics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA. 5. Department of Pediatric Urology, Department of Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA. 6. Department of Pediatric Urology, Department of Urology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. 7. Pediatric Urology Research Enterprise, Department of Pediatric Urology, Division of Urology, Department of Surgery, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, 13123 East 16th Avenue, Mailbox B-463, Aurora, CO, 80045, USA.
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.
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.
Authors: Michael Riccabona; Fred E Avni; Johan G Blickman; Jean-Nicholas Dacher; Kassa Darge; Maria Luisa Lobo; Ulrich Willi Journal: Pediatr Radiol Date: 2009-06-30
Authors: C Black; P Sharma; G Scotland; K McCullough; D McGurn; L Robertson; N Fluck; A MacLeod; P McNamee; G Prescott; C Smith Journal: Health Technol Assess Date: 2010-04 Impact factor: 4.014
Authors: Hiep T Nguyen; C D Anthony Herndon; Christopher Cooper; John Gatti; Andrew Kirsch; Paul Kokorowski; Richard Lee; Marcos Perez-Brayfield; Peter Metcalfe; Elizabeth Yerkes; Marc Cendron; Jeffrey B Campbell Journal: J Pediatr Urol Date: 2010-04-15 Impact factor: 1.830
Authors: David J Chalmers; Sara J Deakyne; Marisa L Payan; Michelle R Torok; Michael G Kahn; Vijaya M Vemulakonda Journal: J Urol Date: 2014-04-30 Impact factor: 7.450
Authors: Michael Riccabona; Fred E Avni; Johan G Blickman; Jean-Nicolas Dacher; Kassa Darge; M Luisa Lobo; Ulrich Willi Journal: Pediatr Radiol Date: 2007-12-11
Authors: L Harper; D Bourquard; C Grosos; O Abbo; C Ferdynus; J L Michel; O Dunand; F Sauvat Journal: J Pediatr Urol Date: 2013-04-17 Impact factor: 1.830