THE IMPACT OF FETAL SCREENING ON INDICATIONS FOR CYSTOURETHROGRAPHY IN INFANTS

To evaluate cystourethrography in the era of fetal screening, we evalu ated retrospectivelt the clinical and imaging findings of all children up to the age of 1 year who underwent a cystourethrogram in a 5-year period (1987-1992). There were 292 children, 64 neonates (< 1 month, 5 1 boys, 13 girls) and 228 infants (1 month-1 year, 111 boys, 117 girls ). Hydronephrosis detected prenatally and confirmed after birth by US was the indication for cystourethrography in 88 children (72 boys, 16 girls). This 4.5 to 1, male to female ratio is very unusual compared t o children with urinary tract infection, the great majority of whom ar e girls. The findings based on imaging studies in these 88 children wi th hydronephrosis included 31 with vesicoureteral reflux (VUR) (in 4 t his was secondary), 23 with obstruction at the ureteropelvic junction (UPJ), 13 with multicystic dysplastic kidney, 2 with obstruction at th e ureterovesical junction, 1 with ectopic ureterocele and 1 with poste rior urethral valves, both the latter without reflux. Eleven children had normal postnatal studies and six children were lost to follow-up. Urinary tract infection (UTI) was the indication in 163 children (62 b oys, 101 girls). Forthy-one children were examined for other causes. A lthough most cases of hydronephrosis were detected on fetal screening, UTI was still the most common indication for cystourethrography and s ome significant abnormalities were found in these symptomatic children .