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Neonatal hydronephrosis due to primary vesicoureteral reflux: trends in diagnosis and treatment
1Department of Radiology, Children's Hospital, Boston, MA 02115.
Insights
Neonatal hydronephrosis due to primary vesicoureteral reflux (VUR) is increasingly detected via fetal screening. Early diagnosis and understanding of VUR pathophysiology enable prompt postnatal treatment.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Hydronephrosis in neonates can stem from primary vesicoureteral reflux (VUR).
- Advances in obstetric ultrasonography have increased the detection rate of congenital urinary tract abnormalities.
- Early identification of at-risk infants is crucial for timely intervention.
Purpose of the Study:
- To evaluate the diagnostic and management strategies for neonatal hydronephrosis caused by primary VUR.
- To identify diagnostic and management errors in a cohort of neonates with VUR.
- To assess the impact of improved screening methods on VUR detection.
Main Methods:
- Retrospective review of medical records for 25 neonates diagnosed with hydronephrosis due to primary VUR between January 1981 and June 1987.
- Analysis of discovery methods, investigations, associated lesions, treatments, and errors in diagnosis and management.
- Evaluation of cases identified through fetal screening versus other methods.
Main Results:
- Twenty-five neonates were identified with hydronephrosis secondary to primary VUR.
- Boys constituted the majority (21/25) of the affected neonates.
- Four cases involved inappropriate maternal/fetal intervention, with three misdiagnosed as posterior urethral valves.
Conclusions:
- Increased detection of neonatal VUR is linked to widespread obstetric ultrasonography and infant screening.
- Understanding VUR pathophysiology facilitates appropriate and timely postnatal therapeutic decisions.
- Despite improved screening, diagnostic and management errors can still occur, necessitating careful evaluation.
Abstract:
The records were reviewed of the 25 neonates found to have hydronephrosis due to primary vesicoureteral reflux at the authors' hospital in the 6 1/2-year period from January 1981 to June 1987. Modes of discovery and investigation, detection of associated lesions, treatment, and errors in both diagnosis and management were evaluated. Twenty-one of the neonates were boys. Fourteen cases were found at fetal screening, and the infants were asymptomatic. Inappropriate maternal/fetal intervention occurred in four cases: Three were incorrectly thought to have posterior urethral valves. The increased number of neonates found to have reflux is attributable to the widespread availability of obstetric ultrasonography and early screening of infants at risk for urinary tract abnormalities. Since the pathophysiologic characteristics of reflux are well understood, appropriate postnatal therapy can be instituted without delay.