原发性梗阻性胆管自发消退:基于早期超声因素的危险分层和预测。

IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Journal of Urology Pub Date : 2025-04-01 Epub Date: 2024-12-02 DOI:10.1097/JU.0000000000004355
Adree Khondker, Jin Kyu Kim, Ihtisham Ahmad, Jethro C C Kwong, Kay Rivera, Camilla B Moreno, Michael E Chua, Mandy Rickard, Armando J Lorenzo
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引用次数: 0

摘要

目的:描述和发展早期超声测量原发性阻塞性megaumeter (POM)自发消退的预测因子。方法:回顾2007年至2023年在我院就诊的POM患儿。POM定义为输尿管扩张bb7mm的输尿管积水。我们排除了其他病因导致上尿路扩张的患者。结果:共纳入159例患者,中位指数年龄为2个月,中位随访时间为30个月。其中,89例患者在监测期间自发消退,1年后手术指征的可能性为30%。APD >015mm、重度肾积水、输尿管扩张>0mm和输尿管扭曲与个体Kaplan-Meier曲线分辨率较低的可能性相关。在这些预测因子上训练的Cox回归模型获得了0.68的校正c指数,低APD仍然与更高的解决可能性相关。结论:POM的早期超声特征,特别是APD,与自发性消退的可能性有关。首次超声检查有高危特征的患者需要更密切的随访。
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Spontaneous Resolution of Primary Obstructive Megaureter: Risk Stratification and Prediction Based on Early Sonographic Factors.

Purpose: We describe and develop predictors for spontaneous resolution of primary obstructive megaureter (POM) from early ultrasound (US) measures.

Materials and methods: Children referred to our institution between 2007 and 2023 for POM were reviewed. POM was defined as hydroureteronephrosis with ureteral dilation > 7 mm. We excluded patients with other etiologies for upper tract dilation. Resolution was defined as decrease in hydronephrosis to < 10 mm anteroposterior diameter (APD) or Society for Fetal Urology grade ≤ 2 or ≤ 7 mm in hydroureter. Patients were censored if they underwent surgical intervention or were lost to follow-up before documenting resolution. Kaplan-Meier curves were drawn to illustrate the cumulative resolution rate and determine univariate associations. Cox proportional hazards regression was performed to identify significant predictors for early resolution, and C index was calculated.

Results: A total of 159 patients were included, with a median index age of 2 months and a median follow-up of 30 months. Of these, 89 patients reached spontaneous resolution during monitoring, and likelihood of surgical indication at 1 year from US was 30%. APD > 15 mm, high-grade hydronephrosis, ureteral dilation > 10 mm, and ureter tortuosity at presentation were associated with a lower likelihood of resolution for individual Kaplan-Meier curves. A Cox regression model trained on these predictors achieved an adjusted C index of 0.68, and low APD remained associated with a higher likelihood of resolution.

Conclusions: Early sonographic features in POM, specifically APD, are associated with the likelihood of spontaneous resolution. Patients with high-risk features at first US warrant closer follow-up.

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来源期刊
Journal of Urology
Journal of Urology 医学-泌尿学与肾脏学
CiteScore
11.50
自引率
7.60%
发文量
3746
审稿时长
2-3 weeks
期刊介绍: The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.
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