[Ten years of prenatal diagnosis of uropathies. Study and conclusions]

Since uropathy started to be diagnosed by means of ultrasonography during the prenatal period, paediatric urologists have experienced a major increase in neonatal consultations, which involve healthy children without any symptoms of urinary tract infection. Thereby the criteria for an adequate treatment of these uropathies have been modified. With our study, we intend to analyse the changes regarding the management of such cases in our Service for the last 10 years. 294 cases prenatally diagnosed and confirmed by means of postnatal sonography have been reviewed, taking into account the type of explorations carried out in order to obtain a definitive diagnosis. Ultrasonography, cystourethrography, pyelography, scintigraphy and isotopic renography have determined both degree of obstruction and the renal function of the patient so as to value the kidney viability. We have found 169 cases of pelviureteral junction (PUJ) obstruction, 52 of vesicoureteral reflux (VUR), 48 of megaureter, 13 of ureterocele, 8 of ectopic ureter, 5 of urethral valves, 26 of multicystic dysplasic kidney, 35 of renal duplication, 4 of renal cyst, 2 of ectopic kidney, 2 of renal agenesia, 3 of bladder diverticular, 1 of renal hypoplasia and 1 of Bolande's tumour. 32 children were operated upon due to PUJ obstruction, 27 due to VUR, 14 megaureter, 21 due to ureterocele and ectopic ureter, 5 due to valves, 5 multicystic kidneys, 3 vesical diverticula, 2 renal cysts and 1 due to Bolande's tumour. From a total of 367 diagnoses, 109 patients have undergone an operation, which equals a 29.7%. The rest of the patients have been subject to a medical follow-up. Only 3 patients had to be operated on due to an aggravation of their obstruction. To sum up, the main advantage of prenatal diagnosis is that it presents the patient without urinary infection. Double-diuretic scintigraphy has proved to be the best option to explore the obstruction when dilated despite its limitations in the case of deficient renal function. The most frequent diagnosis, which has undergone a major increase in the last few years, is PUJ obstruction in the manner of pyelic dilatation. Many of them are not confirmed postnatally and most of them (more than 70%) do not need surgical treatment.