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Antenatal minimal hydronephrosis: is its follow-up an unnecessary cause of concern?
L J Harding1, P S Malone, D G Wellesley
1University of Southampton, Southampton, U.K.
Insights
Follow-up of minimal hydronephrosis (anteroposterior renal pelvis diameter <10 mm) can be modified to reduce parental anxiety. Postnatal ultrasound is needed to exclude uropathy, but repeated antenatal scans are unnecessary.
Area of Science:
- Pediatric Urology
- Prenatal Diagnosis
- Medical Imaging
Background:
- Minimal hydronephrosis diagnosed antenatally (anteroposterior renal pelvis diameter <10 mm) often causes parental concern.
- The necessity and intensity of follow-up for this condition are debated.
Purpose of the Study:
- To evaluate the justification of follow-up for antenatally diagnosed minimal hydronephrosis.
- To assess the impact on parental anxiety and identify optimal investigation pathways.
Main Methods:
- A case-control study utilizing the Wessex Antenatally Detected Anomalies Register.
- Parental questionnaires collected data on antenatal/postnatal follow-up, renal tract morbidity, and parental concern.
- Analysis compared outcomes between subjects with minimal hydronephrosis and controls.
Main Results:
- Postnatal resolution occurred in 43.1% of minimal hydronephrosis cases.
- Coexisting ureteric/calyceal dilatation was associated with higher rates of underlying pathology.
- Subjects experienced significantly greater concern and more frequent thoughts about the diagnosis compared to controls.
- Subjects were also significantly more likely to have a urinary tract infection (UTI).
Conclusions:
- Follow-up protocols for minimal hydronephrosis can be modified to reduce parental anxiety, eliminating the need for repeated antenatal scans.
- Postnatal ultrasound is essential for all patients to rule out underlying uropathy, but investigation intensity can be reduced.
- A less intensive investigation approach combined with clear parental explanation can effectively minimize concerns.
Abstract:
The aim of this study was to determine if follow-up of antenatally diagnosed minimal hydronephrosis (anteroposterior renal pelvis diameter <10 mm) is justified or if it is an unnecessary cause of concern for the parents involved. A case-control study, with subjects and controls selected from the Wessex Antenatally Detected Anomalies Register was performed. Information regarding antenatal and postnatal follow-up, renal tract morbidity and degree of concern was obtained from a parental questionnaire. 70 of the 115 subjects contacted (60.9 per cent) and 52 of the 81 controls (64.2 per cent) returned the questionnaire. 65 of the 70 subjects (92.9 per cent) were rescanned postnatally when 28 cases (43.1 per cent) had resolved. Coexisting ureteric and/or calyceal dilatation was evident postnatally in 12 cases and this group was significantly more likely to have underlying pathology than the group with isolated renal pelvis dilatation. Subjects were significantly more likely than controls to have a UTI. The degree of concern was significantly greater in the subject group and subject parents thought about the result significantly more often than controls. From our results we concluded that the follow-up of minimal hydronephrosis can be modified. There is no need for repeated antenatal scanning, a change that could reduce the level of parental anxiety. Postnatal follow-up is required in all patients to exclude an underlying uropathy but again this can be modified, with the majority of patients requiring only an ultrasound scan. This reduced intensity of investigation accompanied with careful explanation to the parents should help to minimize their concerns.