Obstructive fetal hydronephrosis managed by amnioinfusions and bladder aspirations

Fetuses diagnosed with posterior urethral valve syndrome risk development of significant pulmonary and renal complications. Historically, medical options included expectant management, percutaneous shunting, fetal surgery, and pregnancy termination.

A 34-year-old primigravida presented at 26.5 weeks' gestation with severe fetal hydronephrosis. In lieu of the aforementioned options, the patient elected to undergo serial amnioinfusion and fetal bladder aspirations. The child is now 13 months old and has no evidence of pulmonary compromise but requires peritoneal dialysis.

Serial amnioinfusions combined with fetal bladder aspiration may be beneficial in selected cases of severe fetal hydronephrosis. However, this case demonstrates that fetal urinary electrolytes cannot be used reliably to predict subsequent normal renal function.