Management of the Fetus With a Urinary Tract Malformation

Abstract

Obstetric sonography revealed urinary tract malformations in 13 fetuses. Six had severe dysplastic lesions incompatible with postnatal life; in all six, oligohydramnios and inability to detect normal kidney or bladder allowed appropriate counseling and management. Four fetuses had unilateral lesions (three hydronephrotic, one multicystic); all had evidence of adequate contralateral function and were successfully treated after delivery near term. Three fetuses had bilateral hydronephrosis secondary to urethral obstruction. The two who were born near term died of hypoplastic lungs, end-stage hydronephrosis, and facial and skeletal deformities. The other, electively delivered at 32 weeks, had none of the stigmata of Potter's syndrome, and early decompression salvaged sufficient renal function for survival. Prenatal sonographic assessment of urinary tract anatomy and function can improve perinatal management. The fetus with hydronephrosis may benefit from early decompression.

The role of prenatal diagnosis in the perinatal management of urinary tract abnormalities

“…In fact high urinary obstructions are usually detectable ultrasonically in the second trimester, but are mainly noted in the third trimester of pregnancy. Sometimes clinical pictures such as the variation of amniotic fluid are the first signs of urinary malformation [5,9]. In our experience, oligohydramnios was always associated with a very poor fetal prognosis; on the other hand, polyhydramnios was frequently associated with upper urinary tract obstruction without correlation to fetal prognosis.…”

“…In our experience, oligohydramnios was always associated with a very poor fetal prognosis; on the other hand, polyhydramnios was frequently associated with upper urinary tract obstruction without correlation to fetal prognosis. In the perinatal management of congenital urinary malformation, not only should the character of the amniotic fluid be taken into account, but also the gestational age, the status of fetal development, the L/S amniotic fluid ratio and the potential for intrauterine therapy [4][5][6][7][8][9]. Taking into consideration the gestational age and genetic counselling, the chromosomic analysis of the amniotic fluid is very useful; the association between renal ectopia, hydronephrosis, polycystic kidney and trisomy of chromosomes 9 and 18 is very frequent.…”

Bladder distention and pyelectasis in the male fetus: causes, comparisons, and contrasts.

“…Harrison and coworkers [1][2][3] and other investigators 4,5 have established that the fetus with an obstructed urinary tract may benefit from prenatal decompression. The difficulty arises in identifying which fetuses have obstruction and which fetuses with urinary tract obstruction will truly benefit from decompression.…”

Lower Urinary Tract Obstruction

“…Harrison's group was able to demonstrate that early obstruction resulted in more histological renal damage than obstruction 3 Carr et al have shown, that mid-gestation is the period of greatest renal growth and development. 4 They suggest, that significant obstruction and hydronephrosis in early mid-gestation would have its greatest impact on renal development.…”