Factors affecting the need for ureteral catheterization in symptomatic pregnancy hydronephrosis

Area of Science:

• Urology
• Obstetrics and Gynecology
• Medical Imaging

Background:

• Symptomatic hydronephrosis during pregnancy presents treatment challenges.
• Deciding between conservative management and intervention, such as Double-J Stent (DJS) insertion, requires careful consideration of clinical parameters.
• Identifying reliable predictors for DJS insertion is crucial for optimal patient care.

Purpose of the Study:

• To determine the most appropriate treatment approach for symptomatic gestational hydronephrosis.
• To identify key clinical parameters guiding the decision for Double-J Stent (DJS) insertion.
• To establish cut-off values for hydronephrosis (HUN) degree and renal pelvis anteroposterior (AP) diameter predictive of DJS need.

Main Methods:

• Retrospective cross-sectional study including 137 patients with symptomatic gestational hydronephrosis.
• Patients were categorized into conservative follow-up and DJS insertion groups.
• Evaluated demographic data, clinical parameters, HUN degree via ultrasonography, and renal pelvis AP diameter; investigated factors influencing DJS need.

Main Results:

• Urinary system stones were more prevalent in the DJS group (p=0.014).
• Both HUN degree and renal pelvis AP diameter were significantly higher in the DJS group (p<0.001 for both).
• HUN degree and renal pelvis AP diameter were significant predictors for DJS insertion (p=0.005, p=0.015), with a cut-off AP diameter of 20.5 mm for DJS.

Conclusions:

• HUN degree and renal pelvis AP diameter are critical determinants in choosing between conservative and surgical management for symptomatic hydronephrosis of pregnancy.
• The identified cut-off values for HUN degree and renal pelvis AP diameter can assist clinicians in treatment decision-making.
• These findings provide valuable guidance for managing complex cases of gestational hydronephrosis.