Antenatal Ultrasonogram Detection of Fetal Urinary Tract Dilatation – Evaluation to form Guidelines for Postnatal Risk Stratification and Treatment Plan: A Single-center Study
Abstract
Introduction: The incidence of antenatally detected genitourinary abnormalities is on the rise. Although this has led to earlier interventions and better prognosis, there is a lack of standardization and uniformity in the diagnosis of urinary tract dilatation (UTD) which has resulted in more confusion than before regarding the management. Entities such as “prominent pelvis,” “pelviectasis,” and “hydronephrosis” have been used without any objective criteria which lead to unnecessary and extensive postnatal evaluation.
Aim: This study aims to study the imaging features of those infants with antenatally diagnosed fetal urinary tract dilation and to standardize the protocol for postnatal follow-up and management.
Materials and Methods: A prospective study of 72 mothers who were antenatally diagnosed with fetal UTD were enrolled for the study and postnatal follow-up done by imaging with ultrasound, voiding cystourethrogram, and intravenous urogram.
Results: Among the 72 enrolled cases of 24 were categorized under UTD A1, nine children were managed conservatively with regular follow-up. Those categorized under UTD P1, six cases had normal postnatal scans at the 1st week of life and at 1 month, of which three cases had transient hydronephrosis and two had partial pelviureteric junction obstruction (PUJO). Of 14 children with intermediate-risk dilation UTD P2, 11 children had complete PUJO, two had partial PUJO, and one had bilateral vesicoureteric reflux (VUR), of which patients with complete PUJO required pyeloplasty and the rest needed only observation. Among the 20 neonates with UTD P3 high-risk dilatation, 10 cases of posterior urethral valve, six cases of complete PUJO, one case of obstructive megaureter, one case of VUR, one case of bilateral ureterocele, and one case of non-neurogenic bladder, all of which required surgical intervention except in case of VUR.
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