The Rating System of Urodynamics Upper Urinary Tract in Children under Three Years Old with Congenital Hydronephrosis

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Background. One of the main reasons for the incorrect differentiation of obstructive and non-obstructive disorders of the upper urinary tract (UUT) is age-related morphofunctional immaturity of the kidney and its structures in children of the first three years of life. Aims — to investigate to determine the peculiarities of urodynamic disorders of the UUT in infants with congenital hydronephrosis using diuretic pyeloehography (DРG) method. Methods. There were studied DPG data of 55 patients aged 3–36 months with unilateral hydronephrosis of I–III grades SFU, which were divided into groups in accordance with the variant of violation of the urodynamics of the UUT (obstructive, obstructive-hypertensive and disadaptive). The variants established according to the parameters of the DPG (transient coefficient PUJ (Kpus), the coefficients of postfurosemide adaptation (Ka) and the efficiency of emptying (Ko) pelvis). The obtained data are compared with the conclusions of morphometric studies of the operated 20 children with ureteropelvic junction obstruction (UPJO). Results. The obstructive-hypertensive variant was determined in 18 patients, obstructive — in 20, and disadaptive — in 17. The severity of pelvic dysfunction (according to Ka and Ko) did not correlated to the grade of UPJO (according Kpus) in most cases. Intergroup and intragroup variability in the values of the DРG coefficients is confirmed by the results of PUJ and pelvis morphometry. The correlation between hystological modification in the pelvis and DPG parameters was revealed. Obtained data allowed to introduce a new indicator — urodynamic indicator of quantitative assessment of functional insufficiency of the UUT. And the score gradation of each DРG coefficient (from 0 to 4 points) in accordance with deviation from the reference values was developed. The total indicator functional insufficiency is expressed by the sum of points (SP) for each coefficient (Ka, Ko, Kpus). When SP is less than 3 points — light, 4–6 — moderate, 7–9 — expressed and 10–12 — severe grade of violation of urodynamics. The severity of dysfunctions of the UUT in 88% of children (n = 15) with a disadaptive variant corresponded to light degree, in 75% of patients (n = 14) with an obstructive-hypertensive variant — expressed (50%) and severe (25%) grades. Moderate degree of dysfunction revealed in 65% of patients (n = 13) with an obstructive variant. Conclusion. The severity of urodynamic dysfunction of the UUT in this age group can be determined by the score gradation of the DPG parameters which reflects the functionality of the pelvis/PUJ and the grade of their violation adaptive reactions in response to diuretic.

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About the authors

V. V. Rostovskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
ORCID iD: 0000-0002-3718-8911
SPIN-code: 6989-5041

Russian Federation, Moscow

MD, PhD, Professor

N. А. Кhvatynets

G.N. Speransky City Children’s Hospital No. 9

ORCID iD: 0000-0002-9007-6265
SPIN-code: 9082-7118

Russian Federation, Moscow


G. I. Kuzovleva

G.N. Speransky City Children’s Hospital No. 9

ORCID iD: 0000-0002-5957-7037
SPIN-code: 7990-4317

Russian Federation, Moscow


К. М. Matyushina

G.N. Speransky City Children’s Hospital No. 9

ORCID iD: 0000-0001-6806-8560
SPIN-code: 4922-8638

Russian Federation, Moscow



  1. Pugacevska D, Groma V, Petersons А, et al. Morphological Changes of Ureteropelvic Junction (UPJ) in Case of Congenital Hydronephrosis — Review of Literature. Acta Chirurgica Latviensis. 2013;13(1):72–74. doi:
  2. How GY, Chang KTE, Jacobsen AS, et al. Neuronal defects an etiological factor in congenital pelviureteric junction obstruction. J Pediatr Urol. 2018;14(1):51.e1–51.e7. doi:
  3. Вишневский Е.Л., Ростовская В.В., Сухоруков В.С. Врожденный гидронефроз у детей: всегда ли исход хирургического лечения связан с анатомическими изменениями пиелоуретерального сегмента? // Детская хирургия. — 2003. — № 4. — С. 28–32. [Vishnevsky EL, Rostovskaya VV, Sukhorukov VS. Congenital hydronephrosis in children: is the outcome of surgical treatment always associated with anatomical changes in the pyeloureteral segment? Pediatric surgery. 2003;(4):28–32. (In Russ.)]
  4. Klein J, Bascands JL, Mischak H, Schanstra JP. The role of urinary peptidomics in kidney disease research. Kidney Int. 2016;89:539–545. doi:
  5. Sharman G, Sharma A. Postnatal management of antenatally detected hydronephrosis. World J Clin Urol. 2014;3:283–294. doi:
  6. Nguyen HT, Benson CB, Bromley B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J. Pediatr. Urol. 2014;10:982–998. doi:
  7. Sinha A, Bagga A, KrishnaA, et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr. 2013;50:215–231. doi:
  8. Majd M, Bar-Sever Z, Santos AI, De Palma D. The SNMMI and EANM Procedural Guidelines for Diuresis Renography in Infants and Children. J Nucl Med. 2018;59(10):1636–1640. doi:
  9. Siracusano S, Sanna М, Paoni A, Belgrano E. Role of diuretic dynamic echography in the study of the pyelo-ureteral junction: review of a caseload after the first 4 years of experience. Arch Ital Urol Androl. 1994;64(4):163–167.
  10. Esmaeili M, Esmaeili M, Ghane F, Alamdaran A. Comparison of Diuretic Urography (IVP) and Diuretic Renography for Ureteropelvic Junction Obstruction in Children. Iran. 2016;26(1):e4293. doi:
  11. Sharma A. Comparison of intravenous urography and magnetic resonance urography in preoperative evaluation of pelvi-ureteric junction obstruction in children. J Indian Assoc Pediatr Surg. 2016;21(4):169–174. doi:
  12. Veenboer PW, de Jong TP. Antegrade pressure measurement as a diagnostic tool in modern pediatric urology. World J Urol. 2011;29(6):737–741. doi:
  13. Ростовская В.В., Казанская И.В., Бабанин И.Л., Орликовский О.В. Клиническое значение профилометрии пиелоуретерального сегмента врожденном гидронефрозе у детей // Урология. — 2003. – № 2. — С. 46–50. [Rostovskaya VV, Kazanskaya IV, Babanin IL, Orlikovsky OV. The clinical significance of profilometry of pyeloureteral segment of congenital hydronephrosis in children. Urology. 2003;2:46–50. (In Russ.)]
  14. Piranviseh B, NaroieNejad M, Rezaeimehr B. Сomparison of diuretic sonography and diuretic renal scan in distinction of obstructive and nonobstractive hydronephrosis. RJMS. 2003;9(32):675–680. doi:
  15. Ларионов И.И., Демин А.И., Кузнецов В.М. Диуретическое ультразвуковое исследование почек — метод диагностики нарушения пассажа мочи в лоханочно-мочеточниковом сегменте // Очерки по детской урологии. — М., 1993. — С. 11–12. [Larionov II, Demin AI, Kuznetsov VM. Diuretic ultrasound of the kidneys — a method for diagnosing violations of the passage of urine in the pelvic-ureteric segment. Essays on children’s urology. Moscow; 1993, pp. 11–12. (In Russ.)]
  16. Красовская Т.В., Голоденко Н.В., Левицкая М.В., Гуревич А.И. Анте- и постнатальная диагностика урологических заболеваний у новорожденных // Лекции по педиатрии. Патология новорожденных и детей раннего возраста. — 2001. – № 1. — С. 162–173. [Krasovskaya TV, Golodenko NV, Levitskaya MV, Gurevich AI. Ante- and postnatal diagnosis of urological diseases in newborns. Lectures on Pediatrics. Pathology of Newborns and Young Children. 2001;1:162–173. (In Russ.)]
  17. Пыков М.И., Гуревич А.И., Николаев С.Н., и др. Допплерографическая оценка обструктивных уропатий у новорожденных // Ультразвуковая и функциональная диагностика. — 2003. — Т. 1. — С. 68–75. [Pykov MI, Gurevich AI, Nikolaev SN, et al. Doppler assessment of obstructive uropathy in newborns. Ultrasound and Functional Diagnostics. 2003;1:68–75. (In Russ.)]
  18. Казанская И.В., Ростовская В.В., Бабанин И.Л., и др. Сонографическая диагностика обструктивных нарушений уродинамики верхних мочевых путей при гидронефрозе у детей // Детская хирургия. — 2002. — № 2. — С. 21–26. [Kazanskaya IV, Rostovskaya VV, Babanin IL. Sonographic diagnosis of obstructive disorders of the urodynamics of the upper urinary tract in hydronephrosis in children. Pediatric Surgery. 2002;2:21–26. (In Russ.)]
  19. Бондаренко С.Г., Солоденков С.В., Коробова А.С., Бердникова А.В. Оценка уродинамики лоханочно-мочеточникового сегмента у детей на основе комплексного анализа результатов диуретической ультрасонографии // Вестник ВолГМУ. — 2005. — Т. 15. — № 3. — С. 44–47. [Bondarenko SG, Solodenkov SV, Korobova AS, Berdnikova AV. Diuretic ultrasonography in estimation of urodynamic of pyelo-ureteral segment in children. Interpretation of results with mathematic modeling. Vestnik of Volgograd State Medical University. 2005;3(15):44–47. (In Russ.)]
  20. Koff SA, Binkovitz L, Coley B, Jayanthi VR. Renal pelvis volume during diuresis in children with hydronephrosis: implications for diagnosing obstruction with diuretic renography. J Urol. 2005;174(1):303–307. doi:
  21. Бабанин И.Л., Казанская И.В., Ростовская В.В. Ультразвуковые критерии оценки функционального состояния лоханки и проходимости пиелоуретерального сегмента у детей с гидронефрозом // Детская хирургия. — 2010. — № 2. — С. 15–20. [Babanin IL, Kazanskaya IV, Rostovskaya VV. Ultrasonic criteria for assessing the functional state of the pelvis and the patency of the pyeloureteral segment in children with hydronephrosis. Pediatric Surgery. 2010;2:15–20. (In Russ.)]
  22. Krajewski W, Wojciechowska J, Dembowski J, et al. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. Adv Clin Exp Med. 2017;26(5):857–864. doi:
  23. Krzemień G, Roszkowska-Blaim M, Szmigielska A, et al. Importance of different imaging methods in diagnosis of significant urodynamically uretropelvic junction obstruction in children with congenital hydronephrosis. PolMerkurLekarski. 2008;24(Suppl4):41–45. (In Polish.)
  24. Onen A. An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis. J. Pediatr. Urol. 2007;3(3):200–205. doi:
  25. Ростовская В.В., Хватынец Н.А., Морозова О.Л., Кузовлева Г.И., Сухоруков В.С. Морфология нарушений уродинамики при врожденном гидронефрозе у детей грудного и раннего возраста // Педиатрия. — 2019. — Т. 98. — № 2. — С. 80–87. [Rostovskaya VV, Кhvatynets NА, Morozova ОL, Kuzovleva GI, Sukhorukov VS. Morphology of urodynamic disorders at congenital hydronephrosis in infants and young children. Pediatria. 2019;98(2):80–87. (In Russ.)] doi:
  26. Han SW, Maizels M, Chou PM, et al. Lamina muscularis propria thickness of renal pelvis predicts radiological outcome of surgical correction of ureteropelvic junction obstruction. J. Urol. 2001;165(5):1648–1651. doi:
  27. Kim DS, Noh JY, Jeong HJ, et al. Elastin content of the renal pelvis and ureter determines post-pyeloplasty recovery. J. Urol. 2005;173(3):962–966. doi:
  28. Kaselas C, Aggelidou S, Papouis G, et al.Thickness of the renal pelvis smooth muscle indicates the postoperative course of ureteropelvic junction obstruction treatment. Actas. Urol. Esp. 2011;35(10):605–609. doi:
  29. Gosling JA, Dixon JS. Functional obstruction of the ureter and renal pelvis. A histological and electron microscopic study. Br J Urol. 1978;50(3):145–152. doi:
  30. Ross R, Klebanoff SJ. The smooth muscle cell. I. in vivo synthesis of connective tissue proteins. J. Cell. Biology. 1971;50:159–171. doi:
  31. Hosgor М, Karaca I, Ulukus S, et al. Structural changes of smooth muscle in congenital ureteropelvic junction obstruction. J Pediatr Surg. 2005;40(10):1632–1636. doi:
  32. Starr NT, Maizels M, Chou P, et al. Microanatomy and morphometry of the “obstructed” renal pelvis in asymptomatic infants. J Urol. 1992;148(2Pt2):519–524. doi:
  33. Kim WJ, Yun SJ, Lee TS, et al. Collagen-to-smooth muscle ratio helps prediction of prognosis after pyeloplasty. J Urol. 2000;163:1271–1275. doi:
  34. Разин М.П., Иллек Я.Ю., Саламайкин Н.И. Морфологическое обоснование выбора оперативного лечения врожденного гидронефроза у детей // Нижегородский медицинский журнал. — 2002. — № 4. — С. 14–16. [Razin MP, Illek YYu, Salamaykin NI. Morphological rationale for the choice of surgical treatment of congenital hydronephrosis in children. Nizhny Novgorod Medical Journal. 2002;(4):14–16. (In Russ.)]
  35. Issi O, Deliktas H, Gedik A, et al. Does the Histopathologic Pattern of the Ureteropelvic Junction Affect the Outcome of Pyeloplasty? Urol J. 2015;12(1):2028–2031. doi:

Supplementary files

Supplementary Files Action
Рис. 1. Пример кривой наполнение–опорожнение лоханки при обструктивно-гипертензионном варианте уродинамики (Ка = 0,68; Ко = 0,15; Kpus = 0,11)

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Рис. 2. Пример кривой наполнение–опорожнение лоханки при обструктивном варианте уродинамики (Ка = 4,05; Ко = 0,13; Кpus = 0,72)

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Рис. 3. Пример кривой наполнение–опорожнение лоханки при дезадаптационном варианте уродинамики (Ка = 8,35; Ко = 0,51; Кpus = 2,23)

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Рис. 4. Соотношение средних значений коэффициентов диуретической пиелоэхографии при разных вариантах нарушения уродинамики верхних мочевых путей

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Рис. 5. Прирост исходного объема лоханки (∆Vn) на фоне форсированного диуреза при разных вариантах нарушения уродинамики верхних мочевых путей

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Рис. 6. Соотношение вариантов нарушений уродинамики диуретической пиелоэхографии при разных степенях гидронефроза

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Рис. 7. Процентное соотношение пациентов с различной степенью тяжести нарушений уродинамики верхних мочевых путей (по сумме баллов) при разных вариантах диуретической пиелоэхографии

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