Types and Outcome of Fetal Urinary Anomalies in Low Resource Setting Countries: A Retrospective Study.

Abstract

Congenital anomalies of the kidney and urinary tract in the developing countries have a poor prognosis due to limited experience in antenatal and postnatal management. A 3-year retrospective study was carried out from January 2011 to December 2013. The following data were collected and analyzed: maternal age, gravidity, parity, gestational age at diagnosis, and ultrasonography findings. Final diagnosis after birth, the performed surgeries, follow-up data, as well as survival at one year were also analyzed. The mean age of the included patients was 28years (range 20-35years). The mean parity was 1.7 (range 0-4). The mean gestational age at diagnosis was 26weeks (range 15-36weeks). Consanguinity was reported in 10 cases (24.4%). There were 25 males and 16 females. Bilateral renal agenesis was the commonest type (19.5%). The anomalies of kidneys and urinary tract in our cases were associated with other anomalies in 8 cases (19.5%). Oligohydramnios was detected in bilateral renal agenesis and posterior urethral valve. Surgical interference during the first 6months was performed in 6 cases; pyeloplasty for unilateral or bilateral hydronephrosis was performed in 5 cases; and excision of solitary renal cyst performed in one case. By the end of the first year, two of the three cases with chronic renal disease, who were under peritoneal dialysis, died, and three cases who had undergone pyeloplasty were lost to follow-up. Among the 41 cases with antenatally diagnosed renal and urinary malformations; bilateral renal agenesis was the commonest anomaly (19.5%). There were high rates of induction of abortion, IUFD, and neonatal deaths. The poor outcome may be due to lack of experience in performing invasive therapeutic fetal procedures.