The role of prenatal intervention in obstructive uropathies

Amaç

To determine the benefits and risks of prenatal intervention in obstructive uropathies

Yöntem

Yeven fetuses who underwent 10 prenatal interventions because of a fetal obstructive uropathies between September 2000 and July 2002 were prospectively reviewed. in addition, 7 fetal anomaly cases who followed with no prenatal intervention were reviewed as a control group. The antenatal diagnosis of fetal anomalies was made using prenatal standard ultrasound and diuretic Doppler ultrasound.

Bulgular

Of the 7 fetuses underwent prenatal intervention, 6 had grade 4 UPJ-type obstruction of pelvic diameter greater than 35 mm and one had PUV. Serial renal pelvie needling on 6 fetuses with UPJ-type obstruction and serial vesical needling on fetus with PUV were performed. Urinary system filled up in following day after serial needlings in all fetuses. None of these severe obstructive uropathies resolved/regressed either spontaneously or by needling. Pelviamniotic shunt was placed into three kidneys (one bilateral) with grade 4 UPJ-type obstructions of pelvie diameter greater than 35 mm. Six out of 7 fetuses who underwent prenatal intervention were delivered healthy at term by normal vaginal delivery. All of these patients underwent successful surgery postnatally. The fetus with PUV was terminated with the request of the family before 20 weeks' gestation. Of the control fetuses, 4 had grade 4 UPJ-type obstruction, one PUV, one ureterocele, and one had complete prepucial obstruction. Of these 7 control fetuses, 6 was delivered healthy at term by normal vaginal delivery, while one was terminated with the request of the family before 20 weeks' gestation. After delivery, although all of these 6 neonates underwent successful surgery early postnatally, three had differential renal funetion (GFR) less than 15 at the diseased kidney.

Sonuç If not treated timely and properly, irreversible renal damage may develop in fetuses with severe obstructive uropathies. Prenatal needling seems not sufficient and may not be beneficial in such cases. Prompt prenatal shunting may beneficial in fetuses with severe anatomic urinary obstruction. it may improve postnatal outcome of such cases by preventing irreversible damage prenatally. Such an approach, with experience, seems safe, minimally invasive and beneficial in preserving the growing kidneys in selected cases.

Anahtar Kelimeler

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