Abstract

Aim: The widespread utilization of prenatal ultrasonography and the detection of antenatal hydronephrosis have raised the importance of postnatal follow-up of these infants. In this study, we aimed to determine the importance of an early diagnosis for the management of obstructive urinary tract malformations as well as postnatal radiographic and scintigraphic examinations in infants with obstructive uropathy. Material and Method: Infants whose antenatal ultrasonography showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasonography (7-10th day, 1. month) and voiding cystourethrography (1. month). Infants with vesicoureteral reflux were excluded; 169 patients (222 kidney units) were included in the study. All cases with or without obstructive uropathy as well as patients with obstructive uropathy, who required surgery or no surgery, were evaluated in terms of urinary tract infection, anterior-posterior pelvic diamater on ultrasonography, scars on scintigraphy with Technetium 99m dimercaptosuccinic acid(Tc-99) and differential functions on scintigraphy with Tc- 99. Statistical evaluation was performed using the chi-square and student’s t-tests. Findings: In this study, 54 neonates (71 kidney units) were found to have obstructive uropathy. The median duration of postnatal follow-up was 40 months (range: 12–106 months). The most common detected underlying abnormality was ureteropelvic junction obstruction (in 39 kidney units). The annual urinary tract infection frequency was higher in cases with obstructive uropathy (0.95±0.92 episode/year) than in cases without abnormality (0.41±0.42 episode/year) (p<0.01). Final anteriorposterior pelvic diamater was higher both in cases with obstructive uropathy (14.8±7.8 mm) and in cases who underwent surgery (19±7.7 mm) than in cases without abnormality (8.5±1.6 mm) and in cases who required no surgery (11.7±5.7 mm), respectively (p<0.01). Frequency of scars on scintigraphy with Tc-99m was higher in cases with obstructive uropathy (45 % in first visit, 47 % in final visit) than in cases without obstruction (1.3% in first and final visits) (p<0.01). Conclusion: To evaluate the infants with antenatal hydronephrosis by performing serial ultrasound and other radiological imaging techniques after the first week of postnatal period and to continue close monitoring allow us early recognition of the presence of obstructive uropathy and facilitate for deciding the need for surgery.