Fetal urinoma and prenatal hydronephrosis: how is renal function affected?

Abstract

Objective: In our study, the functional prognosis of kidneys with prenatal urinomas were investigated. Material and methods:Between 2006 and 2010, fetal urinomas were detected in 19 fetuses using prenatal ultrasonography (US), and the medical records were reviewed retrospectively. Of the 19 cases, the follow-up data were available for 10 fetuses. The gestational age at diagnosis, prognosis of urinomas, clinical course and renal functions were recorded. Postnatal renal functions were assessed with renal scintigraphy.Results: Unilateral urinomas and increased parenchyma echogenicity in the ipsilateral kidney were detected in all of the fetuses. Of the 10 fetuses with follow-up data, the option of termination was offered in 6 cases of anhydramnios, including 3 cases with signs of infravesical obstruction (a possible posterior urethral valve (PUV) and poor prognostic factors and 3 cases with unilateral hydronephrosis and increased echogenicity in the contralateral kidney. Only one family agreed the termination. The other 5 fetuses died during the early postnatal period. The average postnatal follow-up period in the 4 surviving fetuses was 22.5 months (8-38 months). One patient with a PUV underwent ablation surgery during the early postnatal period. In the postnatal period, none of the 4 kidneys that were ipsilateral to the urinoma were functional on scintigraphic evaluation. The urinomas disappeared in 3 cases. Nephrectomy was performed in one case due to recurrent urinary tract infections. Conclusion:In our study, no function was detected in the ipsilateral kidney of surviving patients with urinomas. Upper urinary tract dilatation accompanied by a urinoma is a poor prognostic factor for renal function.

Predictive accuracy of prenatal ultrasound findings for lower urinary tract obstruction: A systematic review and Bayesian meta‐analysis

“…Of these papers, 594 were excluded based on exclusion criteria. A total of 46 studies were ultimately included in the Bayesian meta‐analysis (Table ) 8,9,16–59 …”

Successful Treatment of Congenital Hydronephrosis in an Infant Associated with Late-Onset Urinoma: A Case Report

“…[5,14,15] Prenatal urinoma related to UPJO generally is associated with poor functional prognosis of the affected kidney. [2,[16][17][18] Charcos et al collected from the literature from 1985 to 2013, 26 cases (including one own) of prenatal diagnosis of urinoma and UPJO -in almost all of them excluding one -minimal or no function of the kidney was found after birth. [2] The next 7 cases were published by Adorisio et al in 2011, [15] six by Oktar et al in 2013 [18] and nine by Yitta et al in 2014 [14] -also in those cases minimal or no function of the ipsilateral kidney with UPJO and urinoma were noted in surviving patients.…”

Prenatal Diagnosis and Findings in Ureteropelvic Junction Type Hydronephrosis

“…Postnatal normal kidney function in UPJHN cases affected by ipsilateral urinoma is only 7% (28,29). Another study reported that the prognosis is more morbid in the presence of urinoma with prenatal UPJHN than other urinary tract obstructions (11).…”

“…It often develops secondary to obstructive pathologies. Although it is rare, it co-exists with dysplastic non-functional kidney on the same side in 80% of cases (11). Urinary ascites develops in cases with lower urinary tract obstruction following to spontaneous or iatrogenic rupture of the kidney or bladder.…”