Renal duplications: the impact of perinatal ultrasound on diagnosis and management.

Perinatal urology is a rapidly expanding field in pediatric urology bringing significant changes in the diagnosis and management of congenital uropathies. Renal duplication was detected by antenatal and perinatal ultrasound in 19 cases (22 duplicated systems). In most cases, no precise diagnosis could be established in utero (4 of 13), but this lack of accuracy is of little clinical significance since all newborns with suspected uropathies undergo complete urological investigations in the perinatal period. Voiding cystogram demonstrated reflux in 11 of 22 cases. On postnatal urography a functioning upper pole was demonstrated in 11 of 22 kidneys. There were 12 ureteroceles: in 8 a nonfunctioning upper pole was removed, while 3 were endoscopically incised with good functional improvement and 1 was reimplanted. Early recognition of congenital uropathies in association with duplication by prenatal ultrasound significantly improves patient care allowing early postnatal relief of obstruction by less invasive methods and before infection or persistent obstruction worsens the prognosis.