Implicancias del diagnóstico antenatal de dilatación ureteral

Muchos de los hallazgos del diagnostico antenatal de patologia urologica son inespecificos y solo nos permiten diferenciar pacientes con un mayor riesgo de infeccion urinaria o de perder funcion renal. El hecho de identificar un ureter en la ecografia prenatal es un hallazgo inespecifico, que aun no tenemos claro que significa y que pronostico tiene para nuestros pacientes. A partir de noviembre de 1999, tenemos un protocolo prospectivo para el seguimiento y manejo de pacientes con diagnostico antenatal de patologia urologica. Se reviso en forma retrospectiva los pacientes en que hubo dilatacion ureteral en la ecografia prenatal.180 pacientes han sido referidos y seguidos segun protocolo. En 21 pacientes (11.7 por ciento) se ha hecho diagnostico de dilatacion ureteral en la ecografia prenatal. Once hombres y 10 mujeres. Los diagnosticos postnatales de estos pacientes fueron: 4 pacientes con doble sistema pieloureteral; 2 pacientes con megaureteres; 1paciente con una cloaca; 5 pacientes con dilataciones transitorias; 2 pacientes con ureterocele en sistemaunico; 1 paciente con reflujo vesicoureteral en un sistema unico y con un rinon multicistico en el contralateral; 1 paciente con valvas de uretra posterior y 5 pacientes con obstruccion pieloureteral. Un total de 13 pacientes de los 21 requirieron cirugia (62por ciento) y 8 se manejaron medicamente (38.09 por ciento).El hecho de identificar el ureter dilatado en la ecografia prenatal nos permite identificar una poblacion prenatal de riesgo, ya que un 57,1 por ciento de nuestros pacientes requirieron de cirugia. Llama la atencion que 5 pacientes en que se vio el ureter dilatado en la ecografia prenatal, terminaron operandose de obstruccion pieloureteral. Esto apoya la hipotesis de que estas obstrucciones sean secundarias a dilataciones ureterales prenatales. El consejo prenatal tiene que ser dado con cautela y por gente con experiencia, ya que a pesar de existir un riesgo elevado de cirugia...(AU) Prenatal diagnosis is usually non specific and only allows for early detection of patients with a higher risk of developing urinary tract infections or loss of renal function. The identification of the ureter in a prenatal ultrasound is a nonspecific finding. The relevance of this is unknown. A prospective protocol for the management and follow up of patients with antenatal diagnosis of urologicmal formations was started in 1999. We retrospectively review our patients who presented a ureteral dilatation in the antenatal ultrasound.180 patients were referred and follow up was carried out according to protocol. 21 patients (11.7 percent) had ureteral dilatation on the prenatal ultrasound, 11 male and 10 female. The following post natal diagnoses were registered: 4 patients had a duplex kidney, 2 patients had megaureter, 1 patient had a cloaca, 5 patients had transitory dilatations, 2 patients had ureterocele in an single system, 1 patient had VUR in a single system and a contralateral muticystic kidney, 1 patient had posterior urethral valves, and 5 patients had ureteropelvic obstruction.13 of 21 patients required surgery (62 percent), the other 8 required only prophylaxis and follow up (38.09 percent). Being able to identify a dilated ureter in an prenatal ultrasound allowed us to define a high risk group, in which 62 percent required surgery. Of the patients in this group, it is noteworthy that 5 patients in whom a dilated ureter was visualized were operated on for ureteropelvic obstruction. This fact supports the idea that obstructions are secondary to antenatal ureteral dilations. Antenatal advice should be given carefully and by experienced personnel because, although there was a high percentage of surgery in this group, there was also a group of patients that only required antibiotics prophylaxis and image monitoring.(AU)