Residual hydronephrosis after paediatric pyeloplasty: longitudinal APD reference curves

Residual hydronephrosis is common after pyeloplasty and can complicate follow-up. We developed renal pelvic anteroposterior diameter (APD) reference curves to help interpret postoperative ultrasound findings and identify renal units that merit closer review.

We retrospectively reviewed children undergoing primary pyeloplasty for isolated pelvi-ureteric junction obstruction between February 2016 and September 2020. Curves derived from renal units without recurrence described postoperative APD according to preoperative APD and time since surgery. A mixed-effects model accounted for repeated measurements from each renal unit. We compared reoperation rates in units with any measurement above the 90th-centile upper reference curve and those remaining below it.

The cohort included 566 renal units in 550 children. Reference curves used 1,229 measurements from 551 units without recurrence, with median follow-up of 17.0 months. APD decreased most during the early postoperative months and remained higher in renal units with greater preoperative dilatation. At 6 months, the upper reference APD was 23.0 mm for a preoperative APD of 15 mm and 38.4 mm for 70 mm. Among 564 units with documented outcomes, reoperation occurred in 9 of 77 units above the curve (11.7%) and 4 of 487 below it (0.8%; risk ratio 14.23, 95% confidence interval 4.49-45.08). A web calculator compares postoperative APD with the corresponding reference values from 3 to 24 months.

The curves provide a reference for interpreting residual hydronephrosis using routine follow-up ultrasound measurements. APD above the upper curve was associated with more frequent reoperation and can help identify children for earlier reassessment.