Annual Meeting of the Section on Pediatric Urology

Abstract

The Section on Urology of the American Academy of Pediatrics met for three days in conjunction with the 55th Annual Meeting of the Academy n Washington, DC. Papers of interest to the pediatrician are summarized herein according to topic. The number of basic research papers is continuing to increase, and this in no small part is due to the encouraging influence of the recipient of this year's Pediatric Urology Medal, F. Douglas Stephens. FETAL OBSTRUCTIVE UROPATHY The majority of cases of hydronephrosis diagnosed in the newborn are first detected prenatally by in utero ultrasound. It is important to realize that not all cases of renal pelvic distension represent obstruction. Of 100 cases of abnormal antenatal renal ultrasound, Ahmed and LeQuesare found that surgery was necessary in 48 infants. The remainder either had normal kidneys on imaging studies after birth or the dilation was insignificant or decreased with time. The most common abnormality seen was ureteropelvic junction obstruction. Schwarz and coauthors evaluated the efficacy of antenatal ultrasound in diagnosing hydronephrosis at various times during gestation and found a low sensitivity before 20 weeks and a high sensitivity between 35 and 40 weeks. They found that the fetal hydronephrotic kidney did well in utero, leading them to believe that most cases of hydronephrosis should not be tampered with but instead should be dealt with postnatally. Elder and coauthors reviewed the literature to determine whether in utero treatment of fetal obstructive uropathy has been effective. They found numerous instances of misdiagnosis and complications that included inadequate shunt drainage or migration (20%), onset of premature labor within 48 hours (10%), chorioamnionitis (6%), and urinary ascites (6%).