Prenatal intervention for hydronephrosis

Does every patient with prenatal hydronephrosis need voiding cystourethrography

Follow-up evaluation of prenatally recognized vesicoureteric reflux.

Background. Sonographically detected, upper urinary tract wall thickening (UUTWT) was reported to occur in urinary tract infection, urinary tract stone disease, rejection after renal transplantation and vesico-ureteral reflux (VUR). A possible association with obstruction can be hypothesized. 
Objective. The assessment of a potential relationship of UUTWT with VUR or obstruction in patients without one of the above-mentioned conditions. 
Materials and methods. We analyzed 38 patients (74 upper urinary tracts) with at least unilateral UUTWT and concomitant imaging studies such as voiding cystourethrography (VCU), intravenous urography (IVU) and diuretic renography (DR). 
Results. At sonography 49 urinary tracts showed UUTWT. In 33, ipsilateral VUR could be demonstrated at VCU, 11 revealed obstruction at IVU and/or DR, and 4 showed non-obstructive pelvicalyceal dilatation at IVU and DR. In one patient, all imaging studies were normal. The positive predictive value of UUTWT for the presence of VUR was 67.4 % and for obstruction it was 22.5 %. Altogether, UUTWT indicated pathology in 98 % of urinary tracts. 
Conclusion. After exclusion of urinary tract infection, urinary stone disease and prior renal transplantation, the most common associated findings in UUTWT are VUR and obstruction. Therefore, VCU seems to be justified in all cases of UUTWT. Nonrefluxing systems should be further evaluated with DR and/or IVU for exclusion of obstruction.

The sonographically thickened wall of the upper urinary tract system: correlation with other imaging methods

Asymptomatic neonates with urological abnormalities that were discovered antenatally or during screening sonography in the neonatal period differ in a number of important ways from those presenting later with overt clinical signs and symptoms of urological disease. The accumulated experience with these neonates over the past decade has led to important advances in our understanding of the epidemiology, diagnosis, and management of congenital disorders of the urinary tract.

Hydronephrosis in the neonate and young infant: Current concepts

Between 1979 and 1986 an abnormality of the urinary tract was diagnosed by prenatal ultrasound examination in 93 fetuses. Postnatal investigation at a large teaching hospital showed a definite abnormality in 85 infants, 66 of whom were boys. An obstructed urinary tract, usually requiring surgery, was present in 46 infants. Other abnormalities included a multicystic kidney (in 15 infants), vesicoureteric reflux (in 9), prune-belly syndrome (in 5) and polycystic kidneys (in 5). Early recognition and treatment of urinary tract disorders in infants should be accompanied by informed prenatal counselling to minimize parents9 anxiety.

Neonatal outcome of fetuses with urinary tract abnormalities diagnosed by prenatal ultrasonography.

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Neonatal outcome of fetuses with urinary tract abnormalities diagnosed by prenatal ultrasonography.