Journal of pediatric urology · 2026
The role of voiding cystourethrogram in the assessment of bilateral antenatally-detected isolated hydronephrosis.
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Hodhod Amr, Moneir Wael M, Alhams Abdulwahab, Alawwad Ahmed, Almalki Ali, Jamalalail Yasser, Almodhen Fayez, Burki Tariq, Eid Hadeel, Alaqeel Abdullah, Alsufyani Abdullah, Alshammari Ahmed
Аннотация
INTRODUCTION: Isolated hydronephrosis (IH) is considered the most common cause of congenital hydronephrosis. Although voiding cystourethrogram (VCUG) is one of the main diagnostic tools in the workup of IH, there is debate about performing it routinely for all cases. In this study, we evaluated the role of VCUG in assessing bilateral IH in terms of its utility and potential complications. Moreover, we aimed to evaluate the outcome of the management of bilateral HN.
PATIENTS AND METHODS: A retrospective review of patients' charts who presented with IH with non-visualized retrovesical ureters from 2012 to 2023 was conducted. We collected patients' demographics, grade of hydronephrosis, and anteroposterior renal diameter (APD). VCUG results were reviewed, and the grade of vesicoureteral reflux (VUR) was documented. Additionally, any encountered VCUG-related complications were collected. The fate of hydronephrosis was assessed at the last follow-up, including ultrasound scans and the need for surgical intervention.
RESULTS: A total of 111 patients with bilateral IH, where VCUG was done during initial assessment, were included. Twenty-one patients (18.9 %) had VUR; 10 patients (47.6 %) had unilateral VUR, while the remaining were bilateral. None of the refluxing units had APD>20 mm. Of these refluxing patients, only 2 patients had recurrent UTI that required endoscopic intervention. Other refluxing units were managed conservatively. Seven patients (6.3 %) had VCUG-related UTI; all were on antibiotic prophylaxis. No other procedure-related complications were reported. Over a median follow-up of 38 months, 53 (47.7 %) patients showed bilateral resolved HN with conservative management. Sixteen patients (14.4 %) had pyeloplasty.
DISCUSSION: Our findings suggest that routine VCUG in antenatally detected bilateral isolated hydronephrosis is not justified. Avoiding the non-essential screening using VCUG could reduce costs, parental anxiety, and radiation exposure, though careful counseling is essential. Study limitations include retrospective design, average sample size, antibiotic use, and circumcision practice. Being a tertiary center study, the results may not reflect primary care.
CONCLUSION: Almost 19 % of patients had VUR, all of them had APD less than 20 mm. Only 2 of them required surgical intervention for VUR, which questions the importance of routine VCUG studies in bilateral HN. VCUG may not be necessary in asymptomatic patients with IH and APD > 20 mm.
PATIENTS AND METHODS: A retrospective review of patients' charts who presented with IH with non-visualized retrovesical ureters from 2012 to 2023 was conducted. We collected patients' demographics, grade of hydronephrosis, and anteroposterior renal diameter (APD). VCUG results were reviewed, and the grade of vesicoureteral reflux (VUR) was documented. Additionally, any encountered VCUG-related complications were collected. The fate of hydronephrosis was assessed at the last follow-up, including ultrasound scans and the need for surgical intervention.
RESULTS: A total of 111 patients with bilateral IH, where VCUG was done during initial assessment, were included. Twenty-one patients (18.9 %) had VUR; 10 patients (47.6 %) had unilateral VUR, while the remaining were bilateral. None of the refluxing units had APD>20 mm. Of these refluxing patients, only 2 patients had recurrent UTI that required endoscopic intervention. Other refluxing units were managed conservatively. Seven patients (6.3 %) had VCUG-related UTI; all were on antibiotic prophylaxis. No other procedure-related complications were reported. Over a median follow-up of 38 months, 53 (47.7 %) patients showed bilateral resolved HN with conservative management. Sixteen patients (14.4 %) had pyeloplasty.
DISCUSSION: Our findings suggest that routine VCUG in antenatally detected bilateral isolated hydronephrosis is not justified. Avoiding the non-essential screening using VCUG could reduce costs, parental anxiety, and radiation exposure, though careful counseling is essential. Study limitations include retrospective design, average sample size, antibiotic use, and circumcision practice. Being a tertiary center study, the results may not reflect primary care.
CONCLUSION: Almost 19 % of patients had VUR, all of them had APD less than 20 mm. Only 2 of them required surgical intervention for VUR, which questions the importance of routine VCUG studies in bilateral HN. VCUG may not be necessary in asymptomatic patients with IH and APD > 20 mm.