Postnatal outcome of fetal hydronephrosis: Implications for prenatal counselling

Abstract

Objectives: Hydronephrosis is commonly detected during antenatal scans. There are multiple conflicting prognostic factors in the literature with no clear focus on the postnatal outcome. The aim of the study is to assess the outcome of fetal hydronephrosis, based on antenatal sonography.Materials and Methods:Based on the third trimester fetal ultrasound findings, patients were divided into group I (unilateral hydronephrosis) and group II (bilateral hydronephrosis, ureteric dilatation, bladder thickening, etc). Postnatal evaluation and follow-up was performed by a single physician with uniform protocol. The outcomes, spontaneous resolution vs. surgical intervention, were compared between groups. Among group I, further analysis of outcome was done based on 32-week fetal pelvic antero posterior diameter (APD).Results: Among a total of 116 patients in the study group; group I had 78 patients, 7 (9%) required surgery; group II had 38 patients, 21(55%) required surgery. The difference in outcome between the groups was statistically significant (P = 0.002). Among those with unilateral hydronephrosis, none (0/55) with APD <15 mm required surgery, while all patients (4/4) with fetal APD> 30 mm required surgery. In those with APD between 15-30 mm, 3/19 required surgery and prolonged follow-up was required to arrive at the decision. The difference in outcome between the subgroups was statistically significant (P< 0.001, Chi-square test).Conclusions:The results of our study show that simple unilateral fetal hydronephrosis runs a benign course. In the presence hydronephrosis larger than 15 mm, bilateral disease, or bladder distension, detailed postnatal evaluation and regular follow-up is warranted to plan a timely intervention. The above data could be used in prenatal counselling of these parents. Further larger studies are warranted to through more evidence.

Outcome of antenatal hydronephrosis in northeastern Thailand

“…Bilateral hydronephrosis was significantly associated with a requirement for surgical intervention, as reported by Babu et al [11]. As noted by others [4,10,11,16], the other strongly associated variable was a greater degree of severity of ANH. Interestingly, referred patients underwent surgical treatment significantly more often than those born in-hospital.…”

“…This condition-which normally requires no further invasive investigation or treatment-is associated with a milder degree of ANH from AUS findings as in previous studies [4][5][6][7][8][9][10][11]. Additionally, the milder the first PUS is, the more likely the association with transient hydronephrosis.…”

“…Fortunately, none of the patients had progressed to CKD/ESRD, as in similar previous studies [4][5][6][7][8][9][10][11]. However, one of our patients died because of pulmonary hypoplasia and its potential association with hydronephrosis was unclear.…”

“…Patients with ANH also have a higher risk for urinary tract infection (UTI) than the normal population (49%-53%) [9,10]. Prospective studies demonstrated that a more severe degree of ANH and bilateral ANH are associated with a higher risk for UTI and the need for surgical intervention [11]. The objectives of the current study were to determine (a) the causes of ANH, (b) the factors associated with the need for surgical intervention, and (c) the factors associated with complications in patients with ANH.…”

Role of fetal renal pelvic dilatation - as a predictor of neonatal urological outcome

“…10 In those with APD between 15-30 mm, 3/19 required surgery and prolonged follow-up was required to arrive at the decision Oktar T et al reported that the risk of postnatal surgical treatment increased threefold in patients with an APD of 7-20 mm and a diagnosis of caliectasis (relative risk 3.0, 95% confidence interval 1.07-8.40). 11 Signorelli M et al One case from the first group, three cases from the second, and seven cases from the third and 11 cases from the fourth needed surgical treatment.…”