Diagnostic Value of Anteroposterior Diameter of Renal Pelvis for Predicting Postnatal Surgery: A Systematic Review and Meta-Analysis

Abstract

Purpose: We assessed the diagnostic value of anteroposterior diameter of the fetal renal pelvis in predicting postnatal surgery.

Materials and methods: PubMed®, Embase® and Cochrane Library databases were searched for articles comparing patients who underwent surgery or conservative therapy with 15 mm anteroposterior diameter as a cutoff value. Data on sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR and area under the summary ROC curve were used to evaluate the diagnostic value of anteroposterior diameter of the fetal renal pelvis in predicting postnatal surgery.

Results: Five studies involving a total of 1,159 patients met the inclusion criteria. The summary sensitivity and specificity were 0.81 (95% CI 0.60 to 0.92) and 0.78 (95% CI 0.68 to 0.86), respectively. Positive and negative likelihood ratios of anteroposterior diameter were 3.73 (95% CI 2.75 to 5.06) and 0.24 (95% CI 0.11 to 0.52), respectively. Diagnostic OR of anteroposterior diameter for predicting postnatal surgery was 13.33 (95% CI 6.61 to 26.89) and area under the summary ROC curve was 0.85 (95% CI 0.82 to 0.88). Subgroup analysis suggested postnatal anteroposterior diameter was associated with higher diagnostic OR compared to prenatal anteroposterior diameter for predicting postnatal surgery (ratio between prenatal and postnatal anteroposterior diameter 0.27, 95% CI 0.09 to 0.86, p = 0.026).

Conclusions: Using 15 mm anteroposterior diameter of the fetal renal pelvis as a cutoff showed moderate diagnostic value for predicting postnatal surgery.

Keywords: hydronephrosis; kidney pelvis; network meta-analysis; prenatal diagnosis.