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[Therapy and prognosis of children with prenatally diagnosed urinary tract abnormalities]
E Ring1, P Petritsch, M Riccabona
1Universitäts-Kinderklinik, Graz.
Insights
Prenatal diagnosis of urinary tract malformations aids management. Early surgical intervention, often temporary diversion, is common for obstructive uropathy, with successful outcomes and improved prognosis for most infants.
Area of Science:
- Pediatric Urology
- Prenatal Diagnosis
- Surgical Intervention
Background:
- Urinary tract malformations are increasingly detected prenatally.
- Indications and timing for surgical intervention remain debated.
Purpose of the Study:
- To analyze outcomes of surgically managed prenatally suspected urinary tract malformations.
- To evaluate the role of prenatal diagnosis and timing of intervention.
Main Methods:
- Retrospective analysis of 76 infants with prenatally suspected urinary tract malformations.
- Data collected over 80 months, excluding lethal cases.
- Surgical indications based on imaging and functional assessments.
Main Results:
- Obstructive uropathy (67%) and ureteropelvic junction obstruction (47%) were most common.
- 49% of infants required surgery, with 61% in the first month of life.
- 57% of early surgeries were temporary diversions; all reconstructions were successful.
Conclusions:
- Prenatal diagnosis significantly benefits management, especially for severe malformations.
- Delayed surgical intervention based on follow-up is effective.
- Most infants had a good prognosis, with few progressing to renal failure.
Abstract:
Urinary tract malformations are recognized already prenatally to an increasing extent, but the indications for, and the time of surgical intervention are still a matter of debate. The present study is an analysis of the data collected over an 80-month period of 76 patients whose urinary tract malformation was suspected prenatally and confirmed after birth. Patients with lethal malformations whose disease led to abortion or intrauterine death were excluded. Ureteropelvic junction obstruction was present in 47% of the patients and obstructive uropathy accounted for 67% of all malformations. In contrast, vesicoureteric reflux was found only in eight patients. Thirty seven infants (49%) required surgical intervention and 61% of all operations were performed during the first month of life. 57% of these early interventions were temporary diversions. The indication for surgical treatment was based on sonographic and radiological assessment of the malformation and on the results of functional assessment. In many instances surgery was delayed until indicated on the basis of the findings of the follow-up studies. All reconstruction operations were successful. Prenatal diagnosis benefitted most children, especially those with the most severe malformations. No patient died as a result of the renal condition and the prognosis is grave in only one child, who is likely to go into terminal renal failure in childhood.