Prenatal diagnosis and treatment of fetal hydronephrosis (discussion paper)

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Problems in diagnosis and treatment of fetal hydronephrosis at present stageFetal hydronephrosis is a series of clinical syndromes caused by


Problems in diagnosis and treatment of fetal hydronephrosis at present stage

Fetal hydronephrosis is a series of clinical syndromes caused by a series of causes, which is characterized by the expansion of fetal collecting system. The incidence of the disease is about 1.4%. The diagnosis, evaluation and treatment of fetal hydronephrosis are often needed in obstetric, pediatric department of Urology and ultrasound department. However, there are still a lot of controversies about the diagnosis and treatment of hydronephrosis in the world. There are four main aspects of the dispute, that is, the diagnostic criteria, the site of obstruction, the timing of treatment, and the retention of the affected kidney. Ultrasound screening of fetal hydronephrosis and no uniform standard operation, seriously affecting the examination result of diagnosis value, examination results in the lack of comparability between different operators, tracking effect observation and assessment of children with the disease. Many medical workers still have more confusion in clinical work, and can not carry out prenatal diagnosis, evaluation and treatment of fetal hydronephrosis. The meeting aims at the present stage of fetal hydronephrosis diagnosis and treatment of the existing problems, to explore the diagnosis and treatment of fetal hydronephrosis.

Method for screening fetal hydronephrosis

Standard Practice for the measurement of ultrasound screening for fetal hydronephrosis. From the beginning of the 20 week of pregnancy, once every 4 weeks B ultrasound screening, attention to the observation of other than B ultrasound, such as ureteral dilatation or bladder dysplasia. B ultrasound examination of fetal hydronephrosis should include the following parts: to ensure consistency of measurements in basic conditions, is clearly recorded before or after urination urination; including sagittal and coronal ultrasound examination should indicate kidney; hydronephrosis for intrarenal or extrarenal renal parenchyma thickness measurement; to distinguish between the cortex and medulla of the boundary, and the contralateral renal parenchymal thickness contrast; bladder capacity should be determined before and after urination, urination before and after the comparison of hydronephrosis. The above to guide the assessment of fetal renal development, born suffering from kidney infection, whether prophylactic use of antibiotics has reference value.

There are multiple malformations in the fetus, and it is suggested that the karyotype analysis and the multi system abnormalities. For suspected kidney cystonephrosis, megaureter, posterior urethral valve, prune belly syndrome, duplication and ectopic ureter and ureter cyst cases, for further MRI examination. Clinical diagnosis of hydronephrosis in the fetus every 4 weeks B ultrasound review until birth.

Diagnosis and classification of fetal hydronephrosis

At present, the diagnosis of fetal hydronephrosis is no uniform standard, most scholars at home and abroad according to the anteroposterior diameter (APD) to define the congenital hydronephrosis, when the separation of >10mm, clinical diagnosis of fetal hydronephrosis. In the diagnosis of fetal hydronephrosis, the classification of the guiding significance of treatment. At present, there are 3 kinds of commonly used standard for diagnosis and classification of fetal hydronephrosis: Grignon classification, Arger classification, and the American Urological Association standard in 1988. Grignon classification: the first stage was 15mm dilatation of the renal pelvis with mild dilatation of the renal pelvis, and the five stage was moderate dilatation of the renal pelvis. Arger classification: the first degree was 20mm with severe hydronephrosis.

Treatment of fetal hydronephrosis

Treatment of 1 fetal and intrapartum fetal surgery stressed in fetal diseases affecting the normal development of the fetus or damage the function of important organs before the timely surgical intervention, in the fetal period will have a positive meaning of life threatening fetal malformation treatment. At present, fetal surgery is still in its infancy, there are a large number of serious surgical complications and ethical issues. At present, fetal surgery has not yet been carried out in our country, prenatal diagnosis and early intervention of EXIT and neonatal surgery is a good model, which lays the foundation for the future development of fetal surgery.

2 treatment at birth: the effects of oligohydramnios, genital malformations, and other malformations on the neonatal period, as well as the treatment of newborns at birth. For the kidney volume is too large, the impact of natural childbirth of the fetus, the delivery mode of cesarean section.

3 check: most of the prenatal diagnosis of hydronephrosis in children after birth can be checked in the clinic. A series of tests were performed immediately after birth. Whether the newborn radioactive examination is still controversial. Our point of view is that prenatal diagnosis of VCUG in children with hydronephrosis needs to be performed by VCUG after birth, that is, the expansion of >10mm in children with renal pelvis, or the presence of ureteral dilatation. It is necessary to perform VCUG examination, even though ultrasound examination suggests that hydronephrosis has disappeared after birth. For children who are highly suspected of having reflux or emptying, if the VCUG scan shows no reflux, a slow injection of contrast agent into the bladder is performed for VCUG. After the birth of children need to regularly review B ultrasound. Due to the newborn after the birth of physical dehydration, ultrasound examination should be carried out after the birth of 3D, otherwise it will affect the judgment of ultrasound on hydronephrosis. The first ultrasound examination is often performed at 3~4w after birth. When the children born after repeated ultrasound revealed severe hydronephrosis (collection system separation >15mm) and dilatation of the ureters, excretory urography is necessary to check the assessment of urinary tract obstruction and renal function, the ideal is to check the age of one month after birth, can also choose 99 Tc nuclear scan.

4 return flow, lead to bladder ureter megaureter, posterior urethral valve, prune belly syndrome, ectopic ureter, ureter cyst and hydronephrosis should be early surgical treatment.

UPJO should be included in the surgical treatment of children with mild hydronephrosis (APD15mm), such as dilatation of ureter, dilatation of the renal pelvis, thinning of the cortex. For patients with severe hydronephrosis (APD>20mm) or renal dilatation, thinning of the renal cortex, ureteral dilatation and so on, the need for surgical treatment. All of the children who were not treated in the conservative observation, such as the presence of renal emptying disorder, were required to remove the obstruction. Radionuclide scanning revealed renal function

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