Evaluation of postnatal follow-up results in cases diagnosed as antenatal hydronephrosi̇s

There have been dramatic changes in diagnosing the hydronephrosis cases by the widespread use of ultrasonography (US) in antenatal period. The course of the disease at the patients with antenatal hydronephrosis (AH) is much more correlated with underlying diagnosis. Determining the hydronephrosis (HN) cases requiring emergent surgical intervention is our first priority. Another important point is to differentiate the HN cases required long term follow- up or needed surgical intervention in elective cases from the temporary HN cases required minimum invasive monitoring and attempt. In this study we aimed to define the importance of early diagnosis of urinary tract malformation treatment in patients stated sonographically pelvicalyceal dilatation in antenatal period and the importance of antenatal ultrasonographic assessment in detecting urologic malformation and redetermening the diagnosis and treatment protocol used in patient follow-up. This study comprises a total of 250 patients admitted to the hospital with AH diagnosis (followed up and treated) between 2012 and 2015. The patients having the fetal kidney anterior posterior diameters in the second trimester of pregnancy is 4 mm and above, in the third trimester is 7 mm and above have been admitted as antenatal hydronephrosis with antenatal US. If pregnancy week is unkown, the cases with pelvis anterior posterior diameter 7 mm in any prenatal US are received as antenatal HN. After birth first 4 -6 weeks patients, applied urinary ultrasonography for control, with pelvis anterior posterior diameter 7 mm and above are included to the study. Each affected kidney is named as a unit and totally 333 kidney units have been observed. The patients followed by US, voidingcystoureterography (VCUG) and other radiological methods when necessary. One hundred ninety six (79%) of patients were male and 54 (21%) were female. The male/female ratio is 3.6. All patients have been followed from the newborn period and mean follow up time is 26.38±4.62 months (at min. 3, max. 36 months). From the 250 cases, 144(57.6%) cases evaluated as normal and 106 (42.4%) cases diagnosed with a urological pathology in postnatal period. From the 144 patients evaluated as normal at postnatal period, 126 cases evaluated as (50.4%) temporary pelvicalycealectasis and 18 cases (7.2%) as extrarenal pelvis. From the 106 patients diagnosed with a urological pathology, 67 (26.8%) cases diagnosed with ureteropelvic junction (UPJ) obstruction, 29 (11.6%) cases with vesicoureteral reflux (VUR), 5 (2%) cases with ureterovesical junction (UVJ) obstruction, 3 (1.2%) cases with posterior urethral valve (PUV), 1 (0.4%) cases with polycystic kidney disease (PKD), and 1 (0.4 %) cases with multicystic dysplastic kidney (MDK). The subureteric injection is applied to the 7 cases and ureteroneocystostomy operation is applied to 3 patients with the VUR diagnosis. The rest 19 cases are spontaneously recovered and became normal with the folow-up. From the 75 cases with the diagnosis of obstructive pathology, 23 (30.6%) cases operated, 20 (26.7%) cases followed up with the same diagnosis and 32 (42.7%) cases became normal at the follow up. From the operated patients due to obstructive pathology, pyeloplasty is applied to 19 (82.6%) cases, PUV resection is applied to 3 (13.1%) cases and UVJ obstruction surgery is applied to 1 (4.3%) case. In conclusion, the course of the disease at the cases with the diagnosis of antenatal hydronephrosis is correlated with underlying pathology. The application of ultrasonography, which is easily applicable nowadays, to all pregnants is important for the early diagnosis of urinary system pathologies. The evaluation of the infants with urinary system dilatation with the serial ultrasonography and other radiologic evaluation methods beginning from the postnatal first week will provide early diagnosis of urinary system pathologies. Also the babies diagnosed as obstructive pathology with antenatal hydronephrosis are easily understood with ultrasonography but it is difficult to say for the diagnosis of VUR. Therefore we think that the postnatal urinary system infection follow up of AH cases is important at the early diagnosis of VUR and decrease of unnecessary radiation containing radiologic examinations.