[Treatment of urological anomalies detected by prenatal ultrasonography].
By the recent advance in ultrasonography, an increasing number of patients with prenatally detected urological anomalies have been reported. Herein, we present 19 cases experienced in the last 3 years in our institution and review the problems in their diagnosis and treatment. In all cases but 2 ultrasonography revealed fetal abnormalities after the 30th gestational week. No cases with abnormal amniotic fluid or severe fetal growth retardation were experienced. No cases were treated in utero. However, 7 cases required an early delivery because of progressive hydronephrosis or enlargement of tumor mass. Postnatally 6 cases were treated by emergency drainage such as percutaneous nephrostomy and placement of an indwelling catheter. However most of the cases with proven urinary tract dilatation were evaluated by diuretic renogram and followed conservatively thereafter. In equivocal cases, pressure-flow study was added. Spontaneous involution of multicystic kidney was also experienced. Erroneous interpretation can occur in fetal diagnosis and the accuracy of prenatal diagnosis was 52.6% in our series. In determining the management of prenatally detected urological anomalies, several factors such as reliability of ultrasonography, fetal renal function, maturity of the lung and the volume of amniotic fluid, must be taken into consideration. Considering the increasing number of fetuses thus detected, it is very important for the pediatric urologists to make consensus on the fetal intervention and postnatal management.
Department of Urology, Hokkaido University School of Medicine.
T
T
Gotoh
M
M
Kubota
Y
Y
Asano
K
K
Nonomura
M
M
Togashi
T
T
Koyanagi
D005260:Female; D006801:Humans; D008297:Male; D009403:Nephrostomy, Percutaneous; D007690:Polycystic Kidney Diseases / Q000175:diagnosis; D011247:Pregnancy; D011296:Prenatal Diagnosis; D014463:Ultrasonography; D014546:Urinary Catheterization; D014551:Urinary Tract / Q000002:abnormalities* / Q000601:surgery