Does the presence of non-refluxing hydroureter impact the management and outcome of high-grade hydronephrosis?


  • Amr Hodhod McGill University
  • John-Paul Capolicchio
  • Roman Jednak
  • Sunny Wei
  • Mohamed Marzouk Abdallah
  • Abd El-Alim El-Doray
  • Mohamed El-Sherbiny



Hydronephrosis, conservative management, Ultrasonography


Introduction: We aimed to evaluate the impact of non-refluxing hydroureter on the initial management of high-grade hydronephrosis (HGH) management. Moreover, we evaluated the occurrence of febrile urinary tract infection (fUTI) and surgical intervention for conservatively managed units.

Methods: Patients’ charts with postnatal hydronephrosis from 2008‒2014 were retrospectively reviewed. We included patients who presented in the first year of life. All included patients had HGH (Society of Fetal Ultrasound [SFU] grades 3 and 4) and all were non-refluxing using voiding cystourethrogram (VCUG). We categorized renal units into two groups: with hydroureteronephrosis (HUN) and without hydroureter (isolated hydronephrosis [IH]). We recorded the initial management. We evaluated the impact of non-refluxing hydroureter on hydronephrosis fate, fUTI, and change to surgery for those managed conservatively.

Results: We included 169 patients (180 units). IH was diagnosed in 146 units (137 patients), whereas 34 units (32 patients) had HUN. Median followup was 42.9 months. A total of 25.3% (37/146) of IH units had initial surgical management in comparison to 5.1% (2/34) of HUN units (p=0.01). During conservative management, nine HUN patients (30%) and 11 IH patients (10.7%) experienced fUTI (p=0.009). Surgical intervention after failed conservative management was indicated for 12 IH units (11%) and six HUN units (18.8%) (p=0.25). Anteroposterior diameter (APD) worsening was significantly associated with the change to surgery in IH group (p=0.003). More than half (52.3%) of IH units resolved during conservative management in comparison to 18.7% of HUN (p<0.001). HUN had longer time to resolution (log rank=0.004).

Conclusions: IH units had more initial surgical interventions. The fUTI rate was much higher in association with dilated ureter even under antibiotic coverage. HUN was associated with less and slower resolution rate.


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How to Cite

Hodhod, A. ., Capolicchio, J.-P. ., Jednak , R. ., Wei, S. ., Abdallah, M. M. ., El-Doray, A. E.-A. ., & El-Sherbiny, M. . (2019). Does the presence of non-refluxing hydroureter impact the management and outcome of high-grade hydronephrosis?. Canadian Urological Association Journal, 14(3), E94–100.



Original Research