Management of the fetus with urinary tract dilatation

This report describes our experience with 18 pregnant women who presented to our center with suspected fetal urinary tract dilatation. The patients were divided into 4 groups: group I had unilateral fetal urinary tract dilatation and normal amniotic fluid volume, group II had bilateral dilatation and normal amniotic fluid volume, group III had bilateral dilatation and oligohydramnios, group IV had nonurinary tract malformations in addition to urinary tract dilatation. Patients with normal amniotic fluid volume and either unilateral or bilateral fetal dilatation (groups I and II) had a good pregnancy outcome. Patients with oligohydramnios and bilateral dilatation had a poor pregnancy outcome. No intrauterine surgery or shunting was performed in any of the patients. The initial diagnosis of urinary tract dilatation led to the prenatal diagnosis of major nonurologic malformations (group IV) in 3 patients who also had a poor outcome. An algorithm is presented that reflects our experience with the management of these patients and could serve as a guide for others caring for similar patients.