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[Detection of fetal urinary obstructions requiring therapy in routine prenatal ultrasound]
R Thiel1, T A Vögeli, R Ackermann
1Urologische Klinik, Heinrich-Heine-Universität Düsseldorf.
Insights
Routine prenatal ultrasounds can detect fetal urinary tract dilation, but a significant number of cases were missed. This highlights potential issues with equipment and sonographer skill in antenatal screening.
Area of Science:
- Pediatric Urology
- Fetal Medicine
- Diagnostic Imaging
Background:
- Routine prenatal ultrasound screens for fetal malformations.
- Urinary tract infections (UTIs) in infants can be associated with underlying urinary tract abnormalities.
- Antenatal detection of upper urinary tract dilation can inform postnatal management.
Purpose of the Study:
- To evaluate the antenatal detection rate of upper urinary tract dilation (UUD) in infants who later presented with urinary tract infections.
- To identify potential reasons for missed antenatal diagnoses of UUD.
Main Methods:
- Retrospective chart review of 31 children treated for UTI within 19 months postnatally.
- Evaluation of antenatal ultrasound records for the presence of UUD (defined as >3 cm diameter).
- Comparison of antenatal findings with postnatal diagnoses.
Main Results:
- Upper urinary tract dilation was detected antenatally in 18 out of 31 patients (58%).
- Antenatal detection of UUD was missed in 13 patients (42%).
- Potential contributing factors to missed diagnoses included suboptimal sonographic equipment and limited sonographer expertise.
Conclusions:
- A substantial proportion of upper urinary tract dilation cases associated with postnatal UTIs were not identified during routine prenatal ultrasounds.
- Improving the sensitivity of antenatal screening for UUD is crucial for timely postnatal intervention.
- Enhancing sonographic equipment standards and investigator training may improve detection rates.
Abstract:
Routine ultrasound during pregnancy is also performed for the detection of fetal malformations. This retrospective study comprises 31 children treated for urinary tract infection within 19 months postnatally. The charts of the young patients were evaluated how often a dilatation of the upper urinary tract (more than 3 cm in diameter) was observed already during pregnancy. In 18 patients (58%) the dilatation was detected antenatally and was missed in 13 (42%). Reasons of the low sensitivity may include low technical standard of the sonographic equipment and limited skill of the investigators.