Diagnostic and Surgical Approach to Prenatally Detected Urinary Tract Anomalies

Abstract

Regular ultrasound examinations carried out in the second trimester of pregnancy help in detecting many anomalies in the fetal urinary tract. Their percentage ranges from 1% to 3% of all controlled pregnancies. There is a wide spectrum of anomalies that affect the urinary tract, but the most significant are: uretero/hydronephrosis (unilateral or bilateral), kidney agenesis, dysplastic kidney, polycystic and multicystic kidneys, anomalies of ascent, anomalies of kidney rotation or fusion, bladder exstrophy, posterior urethra valve etc. Many of these anomalies do not have impact either on urine flow or on kidney function and hence they can be qualified rather as a condition than as a disease. At the same time, most of the hydronephroses that are seen prenatally are being resolved spontaneously, and they are not detected neither presented postnatally as uretero/hydronephroses of unobstructed type and do not require surgical treatment. Only one tenth of these anomalies are subject to active surgical treatment. Therefore, the assessment of these conditions should be done by a specialized team, who will make adequate therapeutic decisions based on clinical guidelines, as well as will advise the parents on the future clinical implications of the detected anomaly.

Renal pelvis stone in reverse kidney: A case report and literature review

“…With estimated congenital renal and urinary malformations (renal ectopy, cross fusion ectopy, horse shoe, complete ureter, pelvicalyceal system differences, rotation anomalies) present in 3–11% of neonates, the true incidence is unknown 1 . Generally they are discovered incidentally because most of the entities remain asymptomatic.…”

“…Renal malrotations are rare entities with variation in the kidney and hilum positions, more common in males and identified at rates of 1/2000 in autopsy studies. Rotation anomalies are generally unilateral and these people generally remain asymptomatic throughout their lives without urinary system obstruction 1 …”