الفهرس 
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Abstract
Congenital urine flow impairment (UFI) is commonly suspected when a prenatally detected dilatation of the urinary tract is found with a systematic ultrasound scan.
Prenatal ultrasonography allows detection of urinary tract dilatation, mainly at 18-20 weeks’ gestation.
The two most common approaches to define hydronephrosis are the Society for Fetal Urology (SFU) grade and anterior–posterior pelvic diameter(APPD).
A poor prognostic sign in bilateral hydronephrosis is the development of oligohydramnios earlier than the third trimester.
There is a positive correlation between degree of (Prenatal Hydronephrosis) PNH and incidence of VUR which is more severe degrees of PNH are associated with an increased risk of VUR
Mild PNH may not require invasive diagnostic testing (voiding cystourethrogram (VCUG) but rather strict clinical surveillance for UTI and progression of hydronephrosis is required.
The goals of prenatal intervention are to preserve renal function and provide the necessary aqueous environment for lung maturation. Prenatal assessment should consider unilaterality versus bilaterality, presence of oligohydramnios, presumed postnatal diagnosis, evidence of dysplasia on renal ultrasound, renal function as measured by amniotic electrolytes in severe cases, and concurrent congenital diagnoses.
Management options include follow-up ultrasounds in utero, follow-up imaging postnatally, termination of pregnancy, induced early delivery, fetal surgery, and vesico-amniotic shunting.
Prenatally, unilateral hydronephrosis rarely requires intervention, as a normal contralateral kidney will prevent oligohydramnios and intervention has not been proven to improve outcomes.
Only intervention can be considered in the case of severe hydronephrosis causing compression of neighboring organs, specifically the lungs. Intervention in bilateral hydronephrosis is generally limited to boys with outlet obstruction who develop oligohydramnios.
Postnatally, We should evaluate infants with antenatal APPD 5–14 mm immediately after birth, then we should observe them clinically for at least 24 h and Performing US in the first week of life. However, infants with APPD ≥15 mm should be investigated by a paediatrician immediately after birth and observed clinically for at least 24 h. In case of an urgent urologic abnormality, US should be performed after 48 h of life. In all other cases, it should be postponed to the second week of life.
The incidence of VUR in infants with antenatal APPD 5–14 mm is low and the consequences are minor, Because of these minor consequences, performing VCUG in all infants with antenatal APPD 5–14 mm is not recommended. But we should perform VCUG only in cases of ureteric dilatation, a clear sign of VUR.
In cases of calyceal dilatation, a MAG3 scan should be performed to screen for UPJO. In all other cases, follow-up with US alone is sufficient. However, when an infant develops a UTI, we still recommend invasive diagnostics until future studies prove otherwise.
Infants with antenatal APPD ≥15 mm have a high incidence of VUR, with significantly more UTIs and need for surgical correction. Therefore, the contribution of VUR to the development of UTIs in this group is uncertain and the question arises if VCUG is always necessary in this group of infants.
So it is recommended to performe VCUG in this group of infants in cases of bilateral hydronephrosis and/or dilatation of the ureter (s).
Also we should performe a MAG3 scan in all infants with ante- and postnatal APPD ≥15 mm, regardless of calyceal dilatation and unilateral or bilateral hydronephrosis. This is not only to check for UPJO, but equally important to evaluate renal function in these infants with relatively severe hydronephrosis.
If a UTI develops, there are several early studies showed the benefits of long-term antibiotic prophylaxis in the prevention of UTIs.