The 4 year outcome following the demonstration of bilateral renal pelvic dilatation on pre-natal renal ultrasound.

Abstract

There is little in the literature regarding long-term prognosis in cases of fetal pyelectasis and calyceal dilatation. The aim of this study was to correlate antenatal ultrasound findings with outcome in a large group of children, most of whom had routine antenatal mid-trimester scans. 75 babies with bilateral pyelectasis and calyceal dilatation in the pre-natal period and complete radiological and clinical data were identified over a 3 year period. Pre-natal ultrasound was correlated with results of post-natal investigation and the frequency of post-natal surgery was established. Follow-up was documented to discharge or to at least 4 years of age. Prognosis was related to the degree of pelvic dilatation, but neonatal morbidity was much more likely to be associated with pre-natal calyceal dilatation and/or hydroureter. 68% (51 of 75) of babies had insignificant abnormalities on post-natal investigation, defined as either transient fetal pyelectasis and calyceal dilatation, extrarenal pelves, or transient neonatal pyelectasis and calyceal dilatation. Five babies died in the neonatal period, all classified as either moderate or severe disease. Of the surviving 70 cases (93.3%), 27% had renal anomalies that required treatment by prophylactic antibiotics or surgery. The remaining babies were conservatively managed and followed as outpatients. One child required transplantation and a further two had a severe degree of chronic renal failure by the age of 4 years. These data will be of value in prospective counselling.

Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed

“…Similar data were observed by Mami et al who found a complete resolution of bilateral hydronephrosis postnatally in all infants with an APPD of ≤15 mm after a follow-up of 12-14 months [11]. Broadley et al demonstrated that 39 of 42 NBs with bilateral mild isolated hydronephrosis of ≤10 mm had insignificant abnormalities; three showed progression, and two (5%) required surgery [10]. An US follow-up until the first year of life allows for the detection of these few cases of progression.…”

“…In a similar study, Broadley et al found that 42 of 179 NBs (23%) with fetal renal abnormalities had bilateral mild hydronephrosis [10]. Similar data have been reported by other authors [9,11].…”

“…In recent years, the number of papers analyzing the significance of mild isolated antenatal hydronephrosis has been increasing. Even though almost all authors agree that unilateral mild isolated hydronephrosis is a benign condition [1,2,8,9], there have been a few studies reporting on the clinical significance and the outcome of newborns (NBs) with bilateral mild isolated hydronephrosis [9][10][11]. NBs with bilateral hydronephrosis, especially male NBs, are considered to be a group with a higher risk of having a significant abnormality and/or impairment of postnatal renal function [12].…”

Congenital lower urinary tract obstruction: a population‐based epidemiological study

“…This may be because of the subtlety of prenatal diagnosis in some cases, but also because of the overlap between ultrasound appearances between obstructive pathologies and those that are secondary to reflux. 21 Long-term outcomes were worse in fetuses identified prenatally and with co-existent anomalies. Parental choice of TOP was not insignificant in this cohort (and indeed in pregnancies with apparently isolated LUTO).…”

The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction

“…This may be because of the subtlety of prenatal diagnosis in some cases but also because of the overlap between ultrasound appearances between obstructive pathologies and those secondary to reflux. 105 Long-term outcomes were worse in those fetuses identified prenatally and with coexistent anomalies. Parental choice of TOP was not insignificant in this cohort (and indeed in those pregnancies with apparently isolated LUTO).…”