C Grapin1, F Auber, P de Vries, G Audry, P Helardot. 1. Service de Chirurgie Viscérale Pédiatrique, Hôpital Armand-Trousseau, 26, rue du Docteur-Arnold-Netter, 75012 Paris. chir.ped@trs.ap-hop-paris.fr
Abstract
PURPOSE: Antenatal diagnosis of urinary tract anomalies raises the question of appropriate therapeutic management. Two risks should be avoided: excessive treatment, belated treatment. Postnatal management of these infants should be determined before birth. The aim of this study is to define indications more precisely. MATERIALS AND METHODS: A comprehensive review of the literature on postnatal treatment of antenatally diagnosed urinary tract anomalies was performed in order to propose a model of immediate management. RESULTS: Neonates with hydronephrosis should be placed on antibiotic prophylaxis. Postnatal sonographic exploration should be done immediately after birth in case of bilateral pathology, and if renal function is compromised: posterior urethral valves, bilateral dilatation with parenchymal thinning; exploration is done at day 10 in other cases, when diuresis is normalized. Voiding cystourethrogram is performed soon after birth if posterior urethral valves are suspected, later in other cases. In cases of intermittent renal pelvic dilatation, often an indirect sign of reflux, the need for a voiding cystogram is controversial. Diuretic renogram with mercaptoacetyl triglycine (MAG 3) is used to access renal function and efficiency of kidney drainage, both are needed for later monitoring. Surgical treatment is indicated in the event of deteriorated renal function with permanent obstruction. The most common uropathies are ureteropelvic junction obstruction, vesicoureteral reflux, posterior urethral valves, and primary obstructive megaureter. CONCLUSION: Antenatal diagnosis of urinary tract anomalies allowed immediate prophylactic treatment of urinary infections, and decrease the risk of severe complications previously observed. Long-term beneficial effects on preserving the renal parenchyma are yet to be determined.
PURPOSE: Antenatal diagnosis of urinary tract anomalies raises the question of appropriate therapeutic management. Two risks should be avoided: excessive treatment, belated treatment. Postnatal management of these infants should be determined before birth. The aim of this study is to define indications more precisely. MATERIALS AND METHODS: A comprehensive review of the literature on postnatal treatment of antenatally diagnosed urinary tract anomalies was performed in order to propose a model of immediate management. RESULTS: Neonates with hydronephrosis should be placed on antibiotic prophylaxis. Postnatal sonographic exploration should be done immediately after birth in case of bilateral pathology, and if renal function is compromised: posterior urethral valves, bilateral dilatation with parenchymal thinning; exploration is done at day 10 in other cases, when diuresis is normalized. Voiding cystourethrogram is performed soon after birth if posterior urethral valves are suspected, later in other cases. In cases of intermittent renal pelvic dilatation, often an indirect sign of reflux, the need for a voiding cystogram is controversial. Diuretic renogram with mercaptoacetyl triglycine (MAG 3) is used to access renal function and efficiency of kidney drainage, both are needed for later monitoring. Surgical treatment is indicated in the event of deteriorated renal function with permanent obstruction. The most common uropathies are ureteropelvic junction obstruction, vesicoureteral reflux, posterior urethral valves, and primary obstructive megaureter. CONCLUSION: Antenatal diagnosis of urinary tract anomalies allowed immediate prophylactic treatment of urinary infections, and decrease the risk of severe complications previously observed. Long-term beneficial effects on preserving the renal parenchyma are yet to be determined.