Abstract
The routine use of maternal ultrasonography has led to frequent discovery of fetal anatomical abnormalities of the urinary tract. Herein we report on 35 cases with congenital urogenital anomalies which were found during the last 5 years by the prenatal ultrasonography and referred to our clinic either for treatment or consultation.
1. Findings of prenatal ultrasonography
There were 12 cases of hydronephrosis, 7 of multicystic dysplastic kidney, 4 of megaureter, 3 of posterior urethral valve, 2 of ureterocele, 2 of vesicoureteral reflux and 5 other cases. Fetal anomalies were diagnosed durign routine maternal examination, as intrauterine growth retardation, oligohydramnios, or the recurrent risk secondary to genetic risk factor or previous abnormal pregnancies. Prenatal diagnosis was made as eraly as 20 weeks of gestation in a case of hypoplastic urethra with large bladder diverticula. In about 30% of cases, abnormalities were found before 30 weeks of gestation. Oligohydramnios was evident in 5 cases. Prenatal diagnosis was correct in about 60% of cases. In the remainder the diagnosis was either incomplete or incorrect. Errors in the diagnosis resulted from difficulties in the differentiation of dilated ureter, intestinal dilatation or intraperitoneal cystic masses.
2. Management in newborn periods
Of the patients, 12 were treated urologically in newborn periods. Although patients with distended bladder and dilatation of upper tracts first underwent therapeutic placement of the urethral catheter, upper tract diversion with nephrostomy or tubeless ureterocutaneostomy was required in 2 because of continued elevation of serum creatinine levels. In 2 neonates nephrectomy was indicated for unilateral multicystic kidney, because the large cystic mass might compress the intestine. In addition, the serial perinatal ultrasonography demonstrated a gradual increase in the renal size.
3. Treatment and prognosis
Two neonates with polycystic kidney disease and one with bilateral multicystic kidney died of respiratory dysfunction within 24 to 48 hours after birth. One neonate with posterior urethral valve died of multiple anomalies including tracheoesophageal fistula, congenital heart anomaly and 18 trisomy. One infant of Beckwith-Wiedemann syndrome who presented megaureters on prenatal sonography died of respiratory infection when he was 3-month-old. Surgical treatment was performed on 15 patients.
1) Pelvi-ureteric junction stenosis: Three patients underwent pyeloplasty at the age of 1 month to 7 months. Patients with mild hydronephrosis were followed carefully by sonography and diuretic renography at an interval of 3 to 6 months. We experienced no case who showed progression of hydronephrosis during clinical courses.
2) Multicystic dysplastic kidney: Two neonates underwent nephrectomy and one died of bilateral renal involvement. Other patients showed a relative decrease in the size of affected kidney during the follow up periods.
Until recently patients with urinary tract anomalies presented with clinical manifestations such as urinary tract infection or renal dysfunction. The prenatal detection of asymptomatic urinary tract dilatation has presented us both progression and new question in the management of congenital urogenital anomalies.
