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Importance of prenatal detection of hydronephrosis of the upper pole
1Department of Radiology, Children's Hospital, Boston, MA.
Insights
Prenatal detection of upper pole hydronephrosis in duplex systems increased significantly. While prenatal imaging imprecision did not affect outcomes, it reduced infant urinary tract infections and urosepsis.
Area of Science:
- Pediatric Urology
- Neonatal Imaging
- Congenital Anomalies
Background:
- Duplex collecting systems are common congenital anomalies.
- Upper pole hydronephrosis can result from obstruction or reflux.
- Prenatal detection rates have increased significantly.
Purpose of the Study:
- To evaluate the impact of prenatal detection on neonates with upper pole hydronephrosis of a duplex collecting system.
- To assess the diagnostic accuracy of prenatal sonography and its effect on management and outcomes.
- To compare imaging modalities for detecting ureteroceles and reflux.
Main Methods:
- Retrospective review of 40 neonates with upper pole hydronephrosis of a duplex collecting system (1982-1989).
- Analysis of prenatal and postnatal sonography findings.
- Evaluation of voiding cystourethrography (VCUG) for detecting ureteroceles and reflux.
- Comparison of lower pole reflux rates with and without ectopic ureteroceles.
Main Results:
- Prenatal detection increased from <1/year to 6/year.
- 83% of affected neonates were female.
- Prenatal sonography was imprecise (39% accurate) but did not impact management or outcome.
- Postnatal sonography modified prenatal diagnosis in 75% of cases.
- VCUG was the most sensitive and precise imaging technique.
- Lower pole reflux was more common with ectopic ureteroceles (63% vs 33%).
Conclusions:
- Prenatal sonographic detection of upper pole hydronephrosis in duplex systems is increasing.
- Diagnostic imprecision of prenatal sonography did not negatively affect patient outcomes.
- Prenatal detection, coupled with prophylactic antibiotics, reduced symptomatic presentations like urinary tract infection and urosepsis.
- Precise prenatal diagnosis is not essential for effective surgical management.
Abstract:
To determine the impact of prenatal detection on neonates with hydronephrosis of the upper pole of a duplex collecting system, we reviewed 40 such cases seen between June 1982 and April 1989. This six-per-year rate contrasts with fewer than one case per year that was seen at our hospital from 1947 to 1977. Nineteen patients had an ectopic ureterocele, and 21 had an ectopic ureter without a ureterocele. Thirty-three (83%) were girls. Thirty-three cases were discovered because of abnormal findings on a prenatal sonogram, and 20 of those infants were asymptomatic. In the 33 patients whose prenatal sonographic findings were abnormal, the sonogram was diagnostically precise for hydronephrosis of the upper pole of a duplex collecting system in only 39%. This imprecision did not adversely affect management or outcome. Postnatal sonography modified the prenatal diagnosis in 75% of these 33 patients. Voiding cystourethrography was the most sensitive and precise imaging technique for detecting both ureterocele and reflux. Lower pole reflux was almost twice as common when an ectopic ureterocele was present (63%) than when one was not (33%). Prenatal sonographic detection of hydronephrosis of the upper pole of a duplex collecting system decreased the proportion of neonates presenting with urinary tract infection and urosepsis because of prophylactic antibiotics initiated at birth and continued until surgical correction. Precise prenatal diagnosis was not needed for effective surgical treatment.