Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology
Published in: Pediatric Radiology 4/2023

16-07-2022 | Ultrasound | ESPR

Fetal uropathies: pre- and postnatal imaging, management and follow-up

Author: Marie Cassart

Published in: Pediatric Radiology | Issue 4/2023

Login to get access

Abstract

Congenital uropathies are the most common fetal anomalies. They include a wide spectrum of anomalies ranging from mild pelvis dilation to complex urinary tract malformations. Prenatal imaging not only allows for their diagnosis but, in experienced hands, it can differentiate obstructive from refluxing or malformative uropathies. Such precise prenatal information allows for intervention before birth in select cases or for adapting the postnatal workup to provide a better long-term outcome. For the different types of congenital uropathies, we describe their prenatal presentations on US and the complementary role of fetal MRI where indicated. We correlate these findings with postnatal workup and summarize the updated neonatal diagnostic and clinical/surgical management.
Literature
1.
Hindryckx A, De Catte L (2011) Prenatal diagnosis of congenital renal and urinary tract malformations. Facts Views Vis Obgyn 3:165–174
2.
Uv N, Reidv K (2016) Developmental genetics and congenital anomalies of the kidney and urinary tract. J Pediatr Genet 5:51–60
3.
Bulum B, Ozçakar ZB, Ustuner E et al (2013) High frequency of kidney and urinary tract anomalies in asymptomatic first degree relatives of patients with CAKUT. Pediatr Nephrol 28:2143–2147PubMedCrossRef
4.
Ismaili K, Cassart M, Avni EF et al (2016) Antenatal assessment of kidney morphology and function. In: Geary D, Schaefer F (eds) Pediatric kidney disease, 2nd edn. Springer-Verlag, Berlin, pp 49–76CrossRef
5.
Nguyen HT, Phelps A, Coley B et al (2022) 2021 update of the urinary tract dilation (UTD) classification system: clarifications, review of the literature, and practical suggestions. Pediatr Radiol 52:740–751PubMedCrossRef
6.
Coplen DE, Austin PF, Yan Y et al (2006) The magnitude of fetal renal pelvic dilatation can identify obstructive postnatal hydronephrosis, and direct postnatal evaluation and management. J Urol 176:724–727PubMedCrossRef
7.
Loos S, Kemper MJ (2018) Causes of oligohydramniosis: impact on prenatal counseling and postnatal outcome. Pediatr Nephrol 33:541–545PubMedCrossRef
8.
Weitz M, Portz S, Laube GF et al (2016) Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age. Cochrane Database Syst Rev 7:CD010716PubMed
9.
Ismaili K, Piepsz A (2013) The antenatally detected pelviureteric junction stenosis: advances in renography and strategy of management. Pediatr Radiol 43:428–435PubMedCrossRef
10.
Yang Y, Hou Y, Niu ZB, Wang CL (2010) Long-term follow-up and management of prenatally detected, isolated hydronephrosis. J Pediatr Surg 45:1701–1706PubMedCrossRef
11.
Arena S, Chimenz R, Antonelli E et al (2018) A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr 177:1761–1765PubMedCrossRef
12.
Weitz M, Schmidt M, Laube G (2017) Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol 32:2203–2213PubMedCrossRef
13.
Piepsz A, Tondeur M, Nogarède C et al (2011) Can severely impaired cortical transit predict which children with pelvi-ureteric junction stenosis detected antenatally might benefit from pyeloplasty? Nucl Med Commun 32:199–205PubMedCrossRef
14.
15.
Song SH, Park S, Chae SY et al (2017) Predictors of renal functional improvement after pyeloplasty in ureteropelvic junction obstruction: clinical value of visually assessed renal tissue tracer transit in (99m) Tc-mercaptoacetyltriglycine renography. Urology 108:149–154PubMedCrossRef
16.
Gimpel C, Masioniene L, Djakovic N et al (2010) Complications and long-term outcome of primary obstructive megaureter in childhood. Pediatr Nephrol 25:1679–1686PubMedCrossRef
17.
Rubenwolf J, Herrmann-Nuber M, Schreckenberger R et al (2016) Primary non-refluxive megaureter in children: single-center experience and follow-up of 212 patients. Int Urol Nephrol 48:1743–1749PubMedCrossRef
18.
19.
Farrugia MK, Hitchcock R, Radford A et al (2014) British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter. J Pediatr Urol 10:26–33PubMedCrossRef
20.
21.
Nguyen HT, Benson CB, Bromley B et al (2014) Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 10:982–999PubMedCrossRef
22.
Ismaili K, Avni FE, Wissing KM, Hall M (2004) Long-term clinical outcome of infants with mild and moderate fetal pyelectasis: validation of neonatal ultrasound as a screening tool to detect significant nephro-uropathies. J Pediatr 144:759–765PubMed
23.
Tekgül S, Riedmiller H, Hoebeke P et al (2012) EAU guidelines on vesicoureteral reflux in children. Eur Urol 62:534–542PubMedCrossRef
24.
Ismaili K, Hall M, Piepsz A et al (2006) Primary vesicoureteral reflux detected among neonates with a history of fetal renal pelvis dilatation: a prospective clinical and imaging study. J Pediatr 148:222–227PubMedCrossRef
25.
Alvarez N, Delgado Alvira R et al (2018) Predicting long-term renal damage in children with vesicoureteral reflux under conservative initial management: 205 cases in a tertiary referral center. Cent European J Urol 71:142–147PubMed
26.
Maizels M, Alperts S, Houston J et al (2004) Fetal bladder sagittal length: a simple monitor to assess normal and enlarged fetal bladder size and forecast clinical outcome. J Urol 172:1995–1999PubMedCrossRef
27.
28.
Pinette M, Blackstone J, Wax J et al (2003) Enlarged fetal bladder: differential diagnosis and outcomes. J Clin Ultrasound 31:328–334PubMedCrossRef
29.
Fievet L, Faure A, Coze S et al (2014) Fetal megacystis: etiologies, management, and outcome according to the trimester. Urology 84:185–191PubMedCrossRef
30.
Cassart M, Massez A, Metens T et al (2004) Complementary role of MRI after sonography in assessing bilateral urinary tract anomalies in the fetus. AJR Am J Roentgenol 182:689–695PubMedCrossRef
31.
Morris RK, Malin GL, Khan KS, Kilby MD (2009) Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy. BJOG 116:1290–1299PubMedCrossRef
32.
Fontanella F, van Scheltema PNA, Duin L et al (2019) Antenatal staging of congenital lower urinary tract obstruction. Ultrasound Obstet Gynecol 53:520–524PubMedCrossRef
33.
Sarhan O, Nakshabandi Z, Alghanbar M et al (2015) Posterior urethral valve: metabolic consequences in a cohort of patients. J Pediatr Urol 11:216.e1–e6
34.
Ruano R, Sananes N, Sangi-Haghpeykar H et al (2015) Fetal intervention for severe lower urinary tract obstruction: a multicenter case–control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet Gynecol 45:452–458PubMedCrossRef
35.
Morris RK, Malin GL, Quinlan-Jones E et al (2013) Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet 382:1496–1506PubMedPubMedCentralCrossRef
36.
Farrugia MK, Braun MC, Peters CA et al (2017) Report on the Society for Fetal Urology panel discussion on the selection criteria and intervention for fetal bladder outlet obstruction. J Pediatr Urol 13:345–351PubMedCrossRef
37.
Dreux S, Rosenblatt J, Moussy-Durandy A et al (2018) Urine biochemistry to predict long-term outcomes in fetuses with posterior urethral valves. Prenat Diagn 38:964–970PubMedCrossRef
38.
Morris RK, Quinlan-Jones E, Kilby MD, Khan KS (2007) Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction. Prenat Diagn 27:900–911PubMedCrossRef
39.
Hochart V, Lahoche A, Priso R-H et al (2016) Posterior urethral valves: are neonatal imaging findings predictive of renal function during early childhood? Pediatr Radiol 46:1418–1423PubMedCrossRef
40.
Odeh R, Noone D, Bowlin PR et al (2016) Predicting risk of chronic kidney disease in infants and young children at diagnosis of posterior urethral valves: initial ultrasound kidney characteristics and validation of parenchymal area as forecasters of renal reserve. J Urol 196:862–868PubMedCrossRef
41.
Hodges SJ, Patel B, McLorie G, Atala A (2009) Posterior urethral valves. Sci World J 9:1119–1126CrossRef
42.
Hennus PM, van der Heijden GJ, Bosch JL et al (2012) A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys. PLoS One 7:e44663PubMedPubMedCentralCrossRef
43.
Hains DS, Bates CM, Ingraham S, Schwaderer AL (2009) Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 24:233–241PubMedCrossRef
44.
45.
Haddock P, Wagner JR (2015) Seminal vesicle cyst with ipsilateral renal agenesis and ectopic ureter (Zinner syndrome). Urology 85:e41–e42PubMedCrossRef
46.
Santos XM, Dietrich JE (2016) Obstructed hemivagina with ipsilateral renal anomaly. J Pediatr Adolesc Gynecol 29:7–10PubMedCrossRef
47.
Cassart M, Majoub N, Irtan S et al (2019) Prenatal evaluation and postnatal follow-up of ureteral ectopic insertion in multicystic dysplastic kidneys. Fetal Diagn Ther 45:373–380PubMedCrossRef
48.
Sarhan OM, AlghanbarM AA et al (2014) Multicystic dysplastic kidney: impact of imaging modality selection on the initial management and prognosis. J Pediatr Urol 10:645–649PubMedCrossRef
49.
Ismaili K, Avni FE, Alexander M et al (2005) Routine voiding cystourethrography is of no value in neonates with unilateral multicystic dysplastic kidney. J Pediatr 146:759–763PubMedCrossRef
50.
51.
Turkyilmaz G, Cetin B, Sivrikoz T et al (2019) Antenatally detected ureterocele: associated anomalies and postnatal prognosis. Taiwan J Obstet Gynecol 58:531–535PubMedCrossRef
52.
Visuri S, Jahnukainen T, Taskinen S (2018) Prenatal complicated duplex collecting system and ureterocele — important risk factors for urinary tract infection. J Pediatr Surg 53:813–817PubMedCrossRef
53.
Le H-K, Chiang G (2018) Long-term management of ureterocele in duplex collecting systems: reconstruction implications. Curr Urol Rep 19:14PubMedCrossRef
54.
Dannull KA, Browne LP, Meyers MZ (2019) The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol 49:387–391PubMedCrossRef
55.
Alamo L, Laswad T, Schnyder P et al (2010) Fetal MRI as a complement to US in the diagnosis and characterization of anomalies of the genito-urinary tract. Eur J Radiol 76:258–264PubMedCrossRef
56.
Chauvin NA, Epelman M, Victoria T, Johnson AM (2012) Complex genitourinary anomalies on fetal MRI: imaging findings and approach to diagnosis. AJR Am J Roentgenol 199:W222–W231PubMedCrossRef
57.
58.
Wilcox DT, Chitty LS (2001) Non visualisation of the fetal bladder: aetiology and management. Prenat Diagn 21:977–983PubMedCrossRef
59.
Galvo-Garcia MA, Kline-Fath BM, Rubio EI et al (2013) Fetal MRI of cloacal exstrophy. Pediatr Radiol 43:593–604CrossRef
Metadata
Title
Fetal uropathies: pre- and postnatal imaging, management and follow-up
Author
Marie Cassart
Publication date
16-07-2022
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 4/2023
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-022-05433-4

Other articles of this Issue 4/2023

Pediatric Radiology 4/2023 Go to the issue

ESPR

European Society of Paediatric Radiology Artificial Intelligence taskforce: a new taskforce for the digital age

ESPR

Chest radiography and computed tomography imaging in cystic fibrosis: current challenges and new perspectives

ESPR

Benign enlargement of the subarachnoid spaces and subdural collections—when to evaluate for abuse

ESPR

Imaging in neuroblastoma

ESPR

Microfocus computed tomography for fetal postmortem imaging: an overview

ESPR

The fetal brain: migration and gyration anomalies — pre- and postnatal correlations