The antenatally detected pelvi-ureteric junction stenosis: advances in renography and strategy of management
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The antenatally detected pelvi-ureteric junction stenosis: advances in renography and strategy of management Khalid Ismaili & Amy Piepsz
Received: 25 April 2012 / Revised: 1 June 2012 / Accepted: 24 June 2012 # Springer-Verlag 2012
Abstract This review includes an analysis of new developments in the field of renography, the predictive factors suggesting the need for pyeloplasty in cases of pelviutereric stenosis detected antenatally and integration of the pelvi-ureteric junction stenosis within the framework of antenatally detected hydronephrosis. Keywords Hydronephrosis . Pelviureteric junction stenosis . Antenatal . Renography
Introduction The introduction of routine fetal US examination has improved the detection rate of fetal anomalies, while the technical developments of US equipment have increased diagnostic accuracy. These had led to the discovery of many fetal anomalies and, among them, upper urinary tract dilatation is one of the anomalies most amenable to neonatal management [1]. This anomaly, which can be recognised from the beginning of the second trimester of pregnancy, may be an early sonographic sign of pelvi-ureteric junction stenosis (PUJ) [2], or a marker of other abnormalities such as renal duplication or K. Ismaili Department of Paediatric Nephrology, Queen Fabiola Children’s University Hospital, Brussels, Belgium A. Piepsz Department of Radioisotopes, St. Pierre University Hospital, Brussels, Belgium A. Piepsz (*) Department of Radioisotopes, CHU St. Pierre, 322, Rue Haute, 1000 Brussels, Belgium e-mail: [email protected]
vesico-ureteral reflux (VUR) that cannot be easily identified by US during pregnancy [3]. Therefore, the patient is now presenting to the urologist or paediatric nephrologist before the baby is even born, with a presumptive diagnosis rather than a symptom. PUJ stenosis occurs in 13% of children with antenatally diagnosed renal pelvis dilatation [4] and is characterised by a narrowing at the level of the junction between the renal pelvis and the ureter. The anatomical basis for obstruction includes intrinsic stenosis/valves, peripelvic fibrosis, or crossing vessels [5]. In spite of the need for a reliable prognosis concerning the future of infants with prenatally diagnosed PUJ stenosis, postnatal management of these children has remained a controversial topic for the last 25 years [6–9]. This is due to specific difficulties related to these young children, like the initial immaturity of the renal morphology and function and the progressive changes that occur during growth. Technical advances in the field of renography constitute another main factor responsible for diverging opinions about the interpretation of renal function or quality of drainage. Therefore, the definition of renal obstruction, in the particular case of PUJ stenosis, still remains a matter of heavy discussion. The point is of importance for the surgeon who wants to select those PUJ stenoses that might benefit from a surgical procedure. The problem is essentially different when considering se
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