The Outcome of Antenatally Diagnosed Urological Abnormalities

Abstract

Twenty-eight patients undergoing routine antenatal screening by ultrasound were found to have a fetus with a major urological abnormality. In addition, two babies suspected of having an enlarged bladder were found post-natally to be normal. Seven of the 28 pregnancies were terminated before 26 weeks' gestation as a result of the ultrasound findings and all these fetuses had lethal renal abnormalities. Of the remaining 21 babies, four died of renal failure following delivery. Fifteen of the 17 babies who are alive and well had an ultrasound scan before 24 weeks' gestation. Only one of these scans revealed the abnormality. In the remaining patients the abnormality was first detected after 28 weeks. No patient had surgery in utero. Our data suggest that renal abnormalities detected prior to 24 weeks' gestation are associated with severe renal impairment. It appears that the role of antenatal drainage procedures may be of limited value.

Value of antenatal diagnosis of abnormalities of the urinary tract.

“…The overall diagnostic accuracy of antenatal ultrasonography of 74% is similar to that found in comparable series.1 3 The main difficulty was distinguishing between dysplastic, hydronephrotic, and cystic kidneys, and this accounted for most of the inaccurate diagnoses. The diagnosis of renal agenesis is also difficult as the possibility of ectopic renal tissue has to be excluded.…”

Contemporary Trends in Surgical Correction of Pediatric Ureteropelvic Junction Obstruction: Data From the Nationwide Inpatient Sample

“…The debate over the optimal management of prenatal hydronephrosis has been ongoing since the introduction of practical prenatal sonographic screening in the 1980s. 8 Early in the debate a number of authors advocated early intervention to preserve renal function. 1 However, increasingly, observation has been recommended for most infants, as many seem to do well without aggressive surgical intervention, and many urologists prefer to avoid procedures in these young patients.…”

Postnatal evaluation of intrauterine hydronephrosis due to ureteropelvic junction obstruction

“…With the increasing use of ultrasound in the prenatal evaluation from the mid 80's, hydronephrosis began to be diagnosed in intrauterine life [9][10][11] .…”