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The impact of fetal screening on indications for cystourethrography in infants
Insights
Cystourethrography is valuable for diagnosing urinary tract abnormalities in infants, even with widespread fetal screening. Urinary tract infections remain a common reason for the procedure, revealing significant issues in symptomatic children.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Medical Ultrasound
Background:
- Fetal screening for hydronephrosis has become standard, potentially altering the indications for postnatal imaging.
- Cystourethrography plays a role in evaluating congenital urinary tract anomalies.
Purpose of the Study:
- To assess the utility of cystourethrography in children under one year old in the context of prenatal hydronephrosis detection.
- To analyze indications and findings of cystourethrography in neonates and infants.
Main Methods:
- Retrospective review of clinical and imaging data for 292 children under one year who underwent cystourethrography between 1987 and 1992.
- Categorization of indications: prenatal hydronephrosis, urinary tract infection, and other causes.
Main Results:
- Hydronephrosis was the indication in 88 children, with a high male-to-female ratio (4.5:1), revealing vesicoureteral reflux (VUR), ureteropelvic junction (UPJ) obstruction, and multicystic dysplastic kidney.
- Urinary tract infection (UTI) was the most frequent indication (163 children), with significant abnormalities found in symptomatic cases.
- Abnormalities in hydronephrosis group included VUR (31), UPJ obstruction (23), and multicystic dysplastic kidney (13).
Conclusions:
- Cystourethrography remains a crucial diagnostic tool for pediatric urinary tract abnormalities, particularly in cases of urinary tract infection.
- Despite advances in fetal screening, UTI continues to be a primary indication, highlighting the need for prompt evaluation in symptomatic infants.
- The study underscores the diagnostic yield of cystourethrography in identifying diverse urinary tract pathologies in young children.
Abstract:
To evaluate cystourethrography in the era of fetal screening, we evaluated retrospectively the clinical and imaging findings of all children up to the age of 1 year who underwent a cystourethrogram in a 5-year period (1987-1992). There were 292 children, 64 neonates (< 1 month, 51 boys, 13 girls) and 228 infants (1 month-1 year, 111 boys, 117 girls). Hydronephrosis detected prenatally and confirmed after birth by US was the indication for cystourethrography in 88 children (72 boys, 16 girls). This 4.5 to 1, male to female ratio is very unusual compared to children with urinary tract infection, the great majority of whom are girls. The findings based on imaging studies in these 88 children with hydronephrosis included 31 with vesicoureteral reflux (VUR) (in 4 this was secondary), 23 with obstruction at the ureteropelvic junction (UPJ), 13 with multicystic dysplastic kidney, 2 with obstruction at the ureterovesical junction, 1 with ectopic ureterocele and 1 with posterior urethral valves, both the latter without reflux. Eleven children had normal postnatal studies and six children were lost to follow-up. Urinary tract infection (UTI) was the indication in 163 children (62 boys, 101 girls). Forty-one children were examined for other causes. Although most cases of hydronephrosis were detected on fetal screening, UTI was still the most common indication for cystourethrography and some significant abnormalities were found in these symptomatic children.