Pränatale Diagnostik und postnataler Verlauf bei Fehlbildungen der Nieren und Harnwege

Abstract

The authors' own experiences concerning the prenatal diagnosis and postnatal course in 26 foetuses with anomalies of the urinary tract are reported. The malformations observed can be separated into five groups which can also be distinguished sonographically: Urinary tract malformations of poor prognosis, Unilateral cystic kidneys. Hydronephroses, Urinary tract malformations with ascites, Urinary tract malformations in combination with other anomalies of poor prognosis. Sonographic differentiation of the multicystic kidney (Potter type IIA) from the hydronephrosis is usually possible. The recognition of cystic renal dysplasia in urinary tract obstructions (Potter type IV) and the differentiation of renal hypoplasia from renal agenesis is difficult. The dilatation of the urinary system has to be generally regarded as an unspecific symptom, the cause of which can be finally clarified only in the postnatal period. Prenatal invasive diagnostic procedures were carried out only in two foetuses. A concomitant anhydramnios was always associated with a poor prognosis. In the case of unilateral of bilateral dilatation of the urinary tract with normal or slightly diminished amniotic fluid volume, induction of labour or prenatal intervention for drainage in utero was not indicated. The prognosis was infaust in 15 foetuses. One infant died of an unknown cause. Out of 10 surviving infants, six were successfully operated on, in three the dilatation of the urinary tract resolved spontaneously, and one child with prune belly-syndrome has to be catheterised daily.

Fetal urinary tract obstructions: Prenatal diagnosis — prenatal and postnatal therapy

“…The existence of oligohydramnios or anhydramnios with megacystis indicates a prune belly Potter sequence (PBS). When sonography suggests the presence of a megacystis, the differential diagnosis must include mesenterial cysts, deep-seated ileum stenoses, duodenal stenoses, ovarian cysts, cystic renal tumors, teratomas, or cloacal malformations [4,6,7,25,27]. Megacystis is not necessarily caused by a partial or complete obstruction of the urethra, but can arise from a neurogenic bladder, a so-called pseudo-PBS (also in girls), or a megacystis-microcolon-hypoperistaltic syndrome [5,8,14].…”

“…In summary, the prenatal diagnosis of stenoses in the urinary tract provides valuable information to be used in deciding on the prognosis, the date of delivery, and on the best time for intervention and thus helps to prevent irreversible damage caused by recurring infection, urosepsis, and partial or complete loss of renal function [12,26,27].…”