Abstract
The diagnosis, evaluation and management of antenatal hydronephrosis has undergone a two stage paradigm shift since the advent of prenatal ultrasonography in the early 1980s. Initially the identification of a large number of asymptomatic infants appeared to afford the surgeon the opportunity for preemptive intervention. However, it has now become apparent that antenatal hydronephrosis (AH) is far more difficult to interpret thanoriginally perceived. The initial enthusiasm for surgery has now been replaced by a much more conservative approach to ureteropelvic junction(UPJ) obstruction, multi-cystic dysplastic kidney(MCDK), vesicoureteral reflux and the non-refluxing megaureter. This review will highlight the postnatal evaluation of AH and include an overview of the Society for Fetal Urology grading system for hydronephrosis. The differential diagnosis and treatment options for UPJ obstruction, vesicoureteral reflux, MCDK, duplication anomalies, megaureter, and posterior urethral valves will be discussed.
Highlights
The detection of urinary anomalies has changed significantly since the inception of fetal sonography
The mechanism of detection of urinary anomalies has shifted over the last 25 years from the symptomatic patient that may present with a palpable mass, urinary tract infection, or hematuria to the asymptomatic patient that presents with antenatal hydronephrosis (AH)
Controversies exist in the literature, voiding cystourethrogram (VCU) is strongly recommended for the fetus with AH regardless of the initial postnatal ultrasound, race, or gender of the infant
Summary
The detection of urinary anomalies has changed significantly since the inception of fetal sonography. The mechanism of detection of urinary anomalies has shifted over the last 25 years from the symptomatic patient that may present with a palpable mass, urinary tract infection, or hematuria to the asymptomatic patient that presents with antenatal hydronephrosis (AH). Routine screening ultrasounds are typically performed in the U.S during the 18th- to 20th-week gestational age. Fetal renal development begins early in the 5th gestational week, the ability for fetal sonography to detect renal anomalies does not begin until the early 2nd trimester. Appropriate fetal follow-up is based on signs of upper and lower urinary obstruction, in addition to other organ system involvement. The differential is broad, ureteropelvic obstruction (UPJ) is by far the most common anomaly detected
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