The Long-Term Outcome of Fetally Diagnosed Uropathies

Abstract

This retrospective study examines the postnatal management of 87 babies who were diagnosed with prenatal ultrasonography as having some type of urologic abnormality. All of these infants were referred to our pediatric facilty for postnatal urologic care. Of the babies 66 were male and 21 were female. The types of abnormalities seen fall into several diagnostic categories. Urinary obstructions, either at the level of the kidney (UPJ obstruction) or at the ureterovesical junction (UVJ) were the most common diagnosis with 51% of all of the babies falling into either one of these groups. Vesicoureteral reflux was found to be the cause of the prenatal dilation in 18 patients (20.6%) of the total group. Duplication anomalies were present in 7 (8%) of the patients. Posterior urethral valves were found in 7 boys and the triad syndrome (prune belly) in another 4. Multicystic dysplastic kidneys (MCDk) were confirmed to be present by postnatal testing in 6 patients. Considering all of the patients, urologic operations were performed in 36 babies (41%); of these only 6 were performed in the neonatal period, mostly in the patients were valves. Though abnormalities of the urinary system are well visualized prenatally, it is clear that most babies so imaged do not require surgical intervention either in the immediate postnatal period or during infancy. The renal outcome for all of these babies is really quite good; 95.5% of the patients had normal renal function (creatinine <0.7 mg/dl) at long-term follow-up.

Key Words:

• Fetal uropathy
• Prenatal hydronephrosis
• Prenatal ultrasonography