chapter  10
10 Pages

Prenatal diagnosis

ByHK Dhillon

The first case reports of the detection of urinary tract malformations by prenatal (antenatal) ultrasound first appeared in the literature in the mid 1970s, but it was not until the early to mid 1980s that maternal ultrasound was routinely incorporated into obstetric practice in the UK. Since then, a substantial body of experience has accumulated and the management of infants with prenatally detected uropathies constitutes a major component of paediatric urological practice. Abnormalities of the genitourinary tract are amongst the commonest anomalies detected in utero. This partly reflects the relatively high incidence of congenital anomalies within the genitourinary system, but is also because the common anomalies are usually associated with dilatation or cystic pathology which is relatively easy to visualize on ultrasound. Unfortunately, relatively few long-term studies have been undertaken to document the late outcome of prenatally detected uropathies. As a consequence, there are still some unresolved controversies surrounding early surgical intervention or conservative management of conditions such as prenatally detected pelviureteric junction (PUJ) obstruction, multicystic dysplastic kidney, and vesicoureteric reflux (VUR). Whereas progress has been made in identifying criteria to identify subpopulations at greatest risk of later functional deterioration or clinical complications, research has tended to focus on

short-to medium-term outcomes. Further evidence of long-term follow-up studies would be particularly valuable in helping to establish which prenatally detected uropathies are not destined to pose any threat of morbidity and which, indeed, may not warrant any investigation.