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

Abstract

A retrospective study was conducted comprising 78 cases of fetal urinary tract obstructions diagnosed by ultrasound. Thirteen of the obstructions were subvesical and 65 supravesical. In only one fetus with a subvesical obstruction leading to megacystis was a puncture of the fetal bladder performed--in the 17th week of gestation--resulting in restitution of the bladder to its normal size. In all of the remaining fetuses the kidneys, lungs, and bladder changes had already reached an advanced stage by the time the ultrasound diagnosis was made. In the 65 fetuses with supravesical urinary tract obstructions in utero puncture to relieve a rapidly developing hydronephrosis only seemed advisable in two cases. All of the prenatal diagnoses were confirmed postpartum with the exception of two Potter IIa kidneys, which had been interpreted as being hydronephrosis. The time and method of postnatal management are described. The results of the study indicate that in utero intervention is only indicated in the very rare case. Nearly all of the supravesical obstructions remained unchanged, some even for months. In these cases there was no evidence of cystic-dysplastic renal changes after delivery.

Clinical Characteristics and Natural History of Antenatally Diagnosed Fetal Uropathy

“…However, the hydronephrotic type of multicystic dvplastic kidney was mainly composed of a single large cyst and it would be difficult to distinguish it from severe hydronephrosis by an ultrasonographic examination alone [21], The remaining 5 cases showed regional variations in the af fected sites between the antenatal and postna tal diagnoses. Similar discrepancies have also been found in the literature [1,7,16], The rea sons for this might not solely be due to techni cal problems. In other words, it is considered that this phenomenon indicates one of the important characteristics of fetal uropathy.…”

“…By 25 weeks, it is possible to distinguish the cortex from the medulla, to define the renal outline and to see a central echo [15], The gestational age at diagnosis was 29.6 ± 5.8 weeks (range 8-38 weeks) in the present study and this figure was similar to that of Tam et al [12] (27 ± 7 weeks, range 16-39 weeks). In a report on obstructive uropathy by Wilhcm et al [16], the peak age at the time of detection was found to be around 35 weeks of gestation [ 16], In the present series, only 3 cases were de tected before the 20th gestational week (5%), and they were complicated cases with other anomalies than the urinary system. The ear liest one was a case of prune belly syndrome, detected by megaeystis at 8 gestational weeks.…”

Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy

“…Of the initial articles selected on title and abstract, 107 were excluded because they did not meet the selection criteria (Figure 1). A further 10 articles (7.5% of original articles selected) were felt to contain relevant data and the authors were contacted 6,12,35–42 . One of these provided the original dataset and was included 12 .…”

“…A further 10 articles (7.5% of original articles selected) were felt to contain relevant data and the authors were contacted. 6,12,[35][36][37][38][39][40][41][42] One of these provided the original dataset and was included. 12 The final dataset included 13 articles, with a total of 215 women and 33 2 · 2 tables.…”