(556) Trajectory analysis of prenatal urinary tract dilation and risk of postnatal surgery.

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Matthew K. Janssen, MD (he/him/his)

Clinical Assistant Professor
University of Pennsylvania
Philadelphia, PA, United States

Coauthor(s)

MF

Markolline Forkpa, MPH

Pennsylvania Medicine Women's Health Clinical Research Center
Philadelphia, Pennsylvania, United States
DW

Dana Weiss, MD

Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Nadav Schwartz, MD

Professor, Maternal Fetal Medicine
University of Pennsylvania, Perelman School of Medicine
Philadelphia, Pennsylvania, United States

Objective: A prenatal urinary tract dilation (UTD) classification system is associated with postnatal urologic outcomes and assigns a score (UTDA1 or UTDA2-3) depending on anterior-posterior renal pelvis diameter (APRPD) and other markers of renal dysfunction. Postnatal management is dictated by a maximum peri-delivery UTD score and there is limited data assessing the trajectory of UTD across gestation with postnatal outcomes. We aimed to identify trajectories of UTD and describe the association with postnatal surgery.

Study Design: We conducted a retrospective cohort study of infants with congenital UTD, via ICD-10 codes, in visits with pediatric urology at an academic health system and born between 2015-2020 with at least 2 years of follow up. We matched infants to maternal charts and delivery records in the health system. We obtained demographic, obstetric, prenatal ultrasounds, and infant surgical outcomes. We excluded patients without sonographic evidence of UTD prior to delivery as this would not have prompted postnatal follow up, or if there was only a single prenatal ultrasound. Postnatal management followed a standardized algorithm. We performed a trajectory analysis with UTD score and APRPD at multiple gestational ages and assessed their association with postnatal surgery.

Results: There were n=243 matched dyads and n=54 were excluded for missing prenatal ultrasound data, leaving n=189 dyads for analysis. There were no demographic differences between infants with or without postnatal surgery. Three trajectories of UTD score (Figure 1) were identified: stable-high, stable-medium, and escalating groups with postnatal surgery in 27.7% (n=23/83), 4.4% (n=3/68), and 15.8% (n=6/38), respectively, (p< 0.001). Two trajectories for APRPD (Figure 2) were identified with postnatal surgery in 46.2% (n= 18/39) vs 9.3% (n= 14/150, p< 0.001).

Conclusion: UTD score trajectories demonstrated an increased risk of postnatal surgery in stable-high and escalating groups, while a stable-medium risk UTD group conferred a low risk of surgery. ARPRD measures had two trajectories with differing risks of postnatal surgery.