Abstract
Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. 116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.
Highlights
Hydronephrosis detected during fetal life represents a major challenge to the attending physician
The diagnose of urinary tract obstruction in children is made by demonstration of hydronephrosis associated with progressive reduction of renal function assessed by radioisotopes[4,5]
The analysis of sequential images obtained by ultrasound associated with scintigraphic assessment of renal function provides objective tools that helps in the decision make to opt for clinical observation or surgery in those children whose hydronephrosis persists in the post-natal life[6]
Summary
Hydronephrosis detected during fetal life represents a major challenge to the attending physician. Until the mid-80’s, and based on the concept that hydronephrosis was synonymous of obstruction, the surgical treatment was routine[1]. From this decade several studies had shown that the dilation of the urinary tract was not necessarily indicative of obstruction, registering cases of spontaneous regression of hydronephrosis[2,3]. The analysis of sequential images obtained by ultrasound associated with scintigraphic assessment of renal function provides objective tools that helps in the decision make to opt for clinical observation or surgery in those children whose hydronephrosis persists in the post-natal life[6]. The surgical benefits and successful outcome are well defined, providing high cure rates
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