MP17-05 CONFIGURATION AND VALIDATION OF THE TORONTO NOMOGRAM OF ANTENATAL ULTRASOUND INDEX GENERATED FROM BAYESIAN META-REGRESSION ANALYSIS IN PREDICTING POSTERIOR URETHRAL VALVES (PUV) (2022)

You have accessJournal of UrologyCME1 May 2022MP17-05 CONFIGURATION AND VALIDATION OF THE TORONTO NOMOGRAM OF ANTENATAL ULTRASOUND INDEX GENERATED FROM BAYESIAN META-REGRESSION ANALYSIS IN PREDICTING POSTERIOR URETHRAL VALVES (PUV) Michael Chua, Jin Kyu (Justin) Kim, Tim Van Miegham, Joana Dos Santos, Eric Mackay, Lauren Erdman, Marta Skreta, Daniel Keefe, Marisol Lolas, Priyank Yadav, Armando Lorenzo, and Mandy Rickard Michael ChuaMichael Chua More articles by this author , Jin Kyu (Justin) KimJin Kyu (Justin) Kim More articles by this author , Tim Van MieghamTim Van Miegham More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Eric MackayEric Mackay More articles by this author , Lauren ErdmanLauren Erdman More articles by this author , Marta SkretaMarta Skreta More articles by this author , Daniel KeefeDaniel Keefe More articles by this author , Marisol LolasMarisol Lolas More articles by this author , Priyank YadavPriyank Yadav More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002550.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The keyhole sign is considered to be suggestive of a postnatal diagnosis of PUV; however, reliance on this sign may lead to missed diagnoses. Herein, we configured a nomogram using antenatal indices generated from a Bayesian meta-regression analysis and performed a validation study to assess the diagnostic accuracy of the nomogram in comparison to the keyhole sign in predicting a post-natal diagnosis of PUV. METHODS: Antenatal ultrasound indices identified by the Bayesian Meta-regression analysis that were highly predictive of PUV were oligohydramnios, bilateral hydronephrosis, bilateral ureteral dilatation, megacystis, bladder thickening and urinoma. The nomogram was configured as an electronic calculator with the baseline 6% PUV incidence among male fetus with moderate to severe hydronephrosis. The pooled diagnostic odds-ratio generated for each diagnostic index was used as coefficient factor for the nomogram configuration. Using our institutional prenatal consultation database (March 2020-present) validation of the configured nomogram in contrast to the keyhole sign was performed. RESULTS: Based on 63 antenatal consults for male infants with moderate to severe-hydronephrosis, the keyhole sign has a specificity of 100% (95% CI 93.8- 100%) and sensitivity of 60% (95% CI 14.7-94.7), while the nomogram has specificity of 96.55 (5% CI 88.1- 99.6%) and sensitivity of 80 (95% CI 28.4-99.5%). The keyhole sign had 2 false negatives and the nomogram had 2 false positives. The ROC, showed that the nomogram had a superior AUC than the keyhole sign (0.978 vs 0.800, respectively, Figure). The suggested cut-off using Youdin's index for the nomogram was 95% probability to prevent false positives. The calculated NNS was 1.6 for the Keyhole sign and 1 for the nomogram. CONCLUSIONS: This pilot validation study determined that the Toronto antenatal ultrasound indices nomogram calculator for PUV has similar, if not better, diagnostic accuracy than the keyhole sign. Given the long-term implication of missing a PUV diagnosis, the nomogram can be an adjunctive diagnostic tool to trigger additional post-natal screening for patients do not present with classic keyhole sign but have high index of suspicion. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e285 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Chua More articles by this author Jin Kyu (Justin) Kim More articles by this author Tim Van Miegham More articles by this author Joana Dos Santos More articles by this author Eric Mackay More articles by this author Lauren Erdman More articles by this author Marta Skreta More articles by this author Daniel Keefe More articles by this author Marisol Lolas More articles by this author Priyank Yadav More articles by this author Armando Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...