Outcome of Urological Abnormalities Prenatally Diagnosed by Ultrasound

Podevin, Guillaume; Mandelbrot, Laurent; Vuillard, E.; Oury, Jean; Aigrain, Y

doi:10.1159/000264300

Cited by 45 publications

(27 citation statements)

References 29 publications

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“…In this study, underlying diseases are shown in Table 2. Ureteropelvic junction obstruction and VUR were the most common lesions, as reported in the literature [14,15,16,17,18,19,20,21].…”

Section: Discussionmentioning

confidence: 86%

Postnatal management of infants with antenatally detected hydronephrosis

et al. 2005

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With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94+/-5.10 weeks. The mean duration of postnatal follow-up was 26.3+/-13.56 months (range 3-60 months). The mean APPD of the fetal renal pelvis was 10.35+/-3.24 mm (5-9 mm in 84 kidneys, 10-14 mm in 96 kidneys and > or =15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements > or =5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.

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“…In this study, underlying diseases are shown in Table 2. Ureteropelvic junction obstruction and VUR were the most common lesions, as reported in the literature [14,15,16,17,18,19,20,21].…”

Section: Discussionmentioning

confidence: 86%

Postnatal management of infants with antenatally detected hydronephrosis

et al. 2005

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“…It is possible that a perceived 'remoteness' to the time of birth and the potential for spontaneous recovery may have deterred compliance. Podevin et al 11 reported that 43 of 72 (60%) ANH cases diagnosed before 29 weeks were lost to (11) 25 (28) 22 (25) 16 (27) 8 (36) 9 (56)…”

Section: Discussionmentioning

confidence: 99%

Postnatal follow-up of antenatal hydronephrosis: a health-care challenge

et al. 2009

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Objective: To examine our experience with ANH and to determine the success of our postnatal follow-up program.Study Design: Charts of mothers and infants seen (2004 to 2008) at our Regional Perinatal Center were reviewed retrospectively. ANH was defined during the third trimester by anterior pelvic diameters as follows: mild 7 to 9, moderate 10 to 14 or severe X15 mm. Fetuses with multicystic dysplastic kidney (MCDK) were included. Result:Screening of approximately 15 000 ultrasound (US) reports identified 268 fetuses with ANH. After prenatal US surveillance, 88 (33%) fetuses had resolved, while 180 (67%) required postnatal follow-up. These 180 fetuses were diagnosed with mild 38 (21%), moderate 83 (46%) and severe 19 (11%) ANH, uni or bilateral hydroureters 12 (7%), MCDK 19 (10%) and miscellaneous 9 (5%). Postnatal follow-up was successfully established for 75% of infants with hydroureters, 68% for those with MCDK and for 37% of infants with mild, 53% with moderate and 58% with severe ANH. Factors commonly known to influence compliance were not found more frequently among the 91 infants who were lost to follow-up. The only positive predictor for postnatal follow-up was a prenatal consultation with the pediatric urologist. 1-4 The majority of these fetuses recover spontaneously but approximately 40% require postnatal follow-up, and in half of these cases, medical or surgical intervention was needed to prevent significant renal damage. The spectrum of genitourinary abnormalities detected antenatally is varied but the majority of patients have ANH.5 It is commonly accepted that no specific etiology can be identified in 48% of ANH cases.1-5 Physiologic changes are seen in 15%, ureteropelvic and ureterovesical junction obstructions account for 11% of the cases, 9% have vesicoureteral reflux, 4% have unilateral or bilateral megaloureters, 2% of all cases have multicystic dysplastic kidney (MCDK) and 1% have ureterocele. 1,3,6 Regardless of the cause, it is expected that about half of the ANH cases will resolve before delivery or during the first year of life. 2,6 For the other half there will be a need for postnatal follow-up as persistent uropathy is expected to occur in 12% of mild, 45% of moderate and 88% of severe ANH cases.

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“…Há uma grande variabilidade encontrada nestes estudos; a casuística (de 18 a 166 casos), o desenho metodoló-gico, sendo alguns retrospectivos [12][13][14][15] , outros prospectivos [16][17][18][19][20] . Alguns estudos definem a hidronefrose pelo diâmetro ântero-posterior da pelve renal entre 5 e 10 mm como pielectasia, exigindo acompanhamento 15 , porém a maioria considera como sendo hidronefrose quando acima de 10 mm. A distinção entre refluxo e obstrução também resultou em equívocos ao comparar com o diagnóstico pós-natal, uma vez que esta é bastante difícil no exame ecográfico pré-natal 13,14 .…”

Section: Discussionunclassified

Correlação entre o Diagnóstico Morfológico Pré e Pós-Natal das Nefrouropatias Fetais

Pereira¹,

Oliveira²,

Leite³

et al. 2000

Rev. Bras. Ginecol. Obstet.

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IntroduçãoNas últimas décadas, o desenvolvimento de equipamentos ultra-sonográficos tem possibilitado o estudo minucioso de detalhes anatômicos do feto, permitindo um verdadeiro "exame físi-co" pré-natal. A Organização Mundial de Saúde já reconhece o diagnóstico intra-útero como um procedimento do pré-natal 1 . Verifica-se hoje conhecimento progressivo do embrião, do feto e de seu ambiente, sua morfologia, suas funções, seu bem-estar, além das possibilidades de diagnóstico biológico mediante obtenção de amostras de tecidos fetais. Desta forma, o feto passa a ser individualizado como um paciente, no qual as possibilidades de diagnóstico e tratamento intra-uterino efetivamente contribuem para a sua evolução perinatal.Certamente, são as nefrouropatias o grupo de doenças que mais têm se beneficiado dos avanços técnicos da exploração ultra-sonográfica pré-natal 2 . O estudo ecográfico do sistema urinário fetal é bastante favorecido, seja devido ao contraste oferecido entre parte sólida e líqui-da de seus tecidos, seja pela natureza cística da maioria das lesões.

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Outcome of Urological Abnormalities Prenatally Diagnosed by Ultrasound

Cited by 45 publications

References 29 publications

Postnatal management of infants with antenatally detected hydronephrosis

Postnatal management of infants with antenatally detected hydronephrosis

Postnatal follow-up of antenatal hydronephrosis: a health-care challenge

Correlação entre o Diagnóstico Morfológico Pré e Pós-Natal das Nefrouropatias Fetais

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