Prenatal diagnosis and management of mild fetal pyelectasis: implications for neonatal outcome and follow-up.
OBJECTIVE
To describe the natural history of pyelectasis from its detection in the second trimester to delivery, its capability to predict renal pathology and whether prenatal development of pelvic dilatation is correlated to its postnatal evolution.


METHODS
A retrospective analysis involving 375 fetuses with a complete urological follow-up. Prenatal ultrasound was correlated with the results of postnatal investigation and frequency of postnatal surgery was established.


RESULTS
Two-hundred and eighty cases underwent at least two examinations before birth. 73.1% were male fetuses. 57.4% had a bilateral pyelectasis. Prenatal evolution of pelvic dilatation was the following:18.6% of the cases normalized, in 34.6% of the cases the dilatation reduced but did not disappear, in 30.7% it remained unchanged, while it worsened in 16.4%. One case from the first group, three cases from the second, seven cases from the third and 11 cases from the fourth needed surgical treatment. 1.9, 7.2, 18.6, 23.9% of cases respectively worsened after birth in the four groups (trend: P=0.001).


CONCLUSIONS
Prenatal diagnosis of pyelectasis improves the outcome of these children due to a surgical approach that avoids renal damage. There is a good correlation between prenatal evolution and postnatal outcome, although a postnatal follow-up is opportune in those cases that normalized before birth.
Signorelli
Marino
M
Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, University of Brescia, Spedali Civili, Brescia, Italy. marino.signorelli@libero.it
Cerri
Valeria
V
Taddei
Fabrizio
F
Groli
Caterina
C
Bianchi
Umberto A
UA
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005865:Gestational Age; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D007231:Infant, Newborn; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D013520:Urologic Surgical Procedures
D000900:Anti-Bacterial Agents