Congenital hydronephrosis who requires intervention?

PURPOSE: To analyze the predictive value of early postnatal ultrasonography in congenital hydronephrosis. SUBJECTS AND METHODS: A retrospective study was conducted of 77 affected infants at our institution. All postnatal ultrasound studies were evaluated using 2 classification systems, the Anterior-Posterior Diameter (APD) system and the Society for Fetal Urology (SFU) system. Each study was compared to subsequent ultrasound examinations, renal scans, and to clinical outcome. RESULTS: There were 115 dilated renal units. Fifteen (13%) underwent intervention; all initially had high grade hydronephrosis on both classification systems. One hundred renal units (87%) were managed conservatively; 47 had low grade hydronephrosis and only 18 had high grade hydronephrosis on both systems. CONCLUSIONS: Using both the APD and the SFU classification systems together on the initial postnatal ultrasound is superior to using either method on its own, and the combined system enables us to predict the outcome of infants with congenital hydronephrosis.