Prenatal hydronephrosis: Bridging pre‐ and postnatal management

Abstract

Urinary tract dilation (UTD), including hydronephrosis (HN) is the most common prenatally detected anomaly and affects up to 1%–2% of pregnancies. Postnatally, it resolves without surgical intervention in approximately 75%–80% of children, however this may take several years to occur, necessitating repeated clinic visits and additional invasive testing for many. For the remainder, a surgical intervention will be offered to relieve obstruction or to correct vesicoureteral reflux. During the monitoring period, many of these infants will be offered continuous antibiotic prophylaxis for the prevention of urinary tract infections, however this remains a controversial topic among pediatric urologists and nephrologists. Herein, we present an up‐to‐date review of the early management of prenatally detected UTD including timing of postnatal imaging, the use of antibiotics, when circumcision may be beneficial and long term outcomes of the most common HN etiologies. We also propose a decision making tool to help guide the care of infants with UTD.

Risk Factors of Urinary Tract Infection in Pediatric Patients with Ureteropelvic Junction Obstruction after Primary Unilateral Pyeloplasty

“…The incidence of UTI is up to 7.8%-10.0% when stents are left [11,12]. Accordingly, prescription of prophylactic oral antibiotics is suggested by some pediatric urologists to decrease the risk of UTI following pyeloplasty during the placement of double-J stents [13]; although, very few patients with ureteral stents, particularly those with stent duration lasting no more than 3 months, show clinically symptomatic UTI [14]. Whether there are other risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty is largely unknown.…”

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System

“…In addition, delivery should take place in a high-risk fetal center to ensure immediate assessment by appropriate pediatric specialties equipped to manage potential complications. 9 The severity of this condition and its implications stress the importance of obtaining an accurate and reliable prenatal diagnosis. Our previous work has explored the power of combinations of prenatal ultrasound features 3 to strengthen the prediction of LUTO.…”

Prenatal Detection of a FOXF1 Deletion in a Fetus with ACDMPV and Hydronephrosis

“…While hydronephrosis may coexist with various genetic diseases, including ACDMPV, it is more frequently detected as an isolated condition [ 15 ]. Hydronephrosis occurs in 1–2% of pregnancies and is one of the most common defects detected during routine prenatal ultrasound evaluation in the second or third trimester [ 16 ]. In approximately 80% of cases, hydronephrosis is transient and resolves in early life with conservative management [ 16 ].…”

“…Hydronephrosis occurs in 1–2% of pregnancies and is one of the most common defects detected during routine prenatal ultrasound evaluation in the second or third trimester [ 16 ]. In approximately 80% of cases, hydronephrosis is transient and resolves in early life with conservative management [ 16 ]. However, the likelihood of spontaneous resolution depends on the severity of the anomaly and, in some cases, surgical intervention is needed within the postnatal period [ 16 ].…”

“…In approximately 80% of cases, hydronephrosis is transient and resolves in early life with conservative management [ 16 ]. However, the likelihood of spontaneous resolution depends on the severity of the anomaly and, in some cases, surgical intervention is needed within the postnatal period [ 16 ].…”