[Management of uropathies diagnosed prenatally. Discussion based on a series of 53 cases]

From 1982 to 1986, 53 newborns (26 boys and 27 girls) were referred to the authors for the management of a congenital anomaly of the urinary tract, following a prenatal ultrasonographic diagnosis. The postnatal diagnosis was hydronephrosis in 27 children (10/27 bilateral cases), unilateral multicystic dysplasia in 11, ureteral duplication in 6, primary megaureter or orthotopic ureterocele in 5 (1/5 bilateral case) and posterior urethral valves in 4. An early urinary tract infection was noticed in 5 cases only and 2 boys with urethral valves had an altered renal function at birth. Eight children with a mild lesion were not operated. A radical procedure was performed in 15 cases: excision of a multicystic kidney (10 cases) or heminephrectomy of an upper non-functioning pyelon (5 cases: 3 with heterotopic ureterocele and 2 with ectopic ureter). Thirty children were submitted to a corrective procedure: electrocoagulation of urethral valves (4 cases), ureteroneocystostomy (6 cases) or pyeloplasty (19 unilateral and 1 bilateral procedure). Except in a case of pyeloplasty the result of the reconstructive surgery was considered as good or satisfactory from a radiological point of view, with a mean follow-up of 1.5 year. The essential point of discussion is the evaluation of the factors which must be taken in account to plan an early reconstructive surgical treatment. The main factor, I.e. the natural history of these congenital anomalies remains at yet difficult to predict in a great number of cases.(ABSTRACT TRUNCATED AT 250 WORDS)