PRENATAL-DIAGNOSIS OF DUPLEX SYSTEM HYDRONEPHROSIS - EFFECT ON RENAL SALVAGE

Objectives: To determine if prenatal identification of significant ren al duplication anomalies affects the management of the patient or the clinical outcome. Methods: This is a retrospective review of 79 consec utive children with severe hydronephrosis involving a duplex renal col lecting system, identified by either prenatal ultrasound (asymptomatic ), or symptoms, most. often urinary tract infection, but also includin g abdominal mass, hematuria, or incontinence. An individualized combin ation of voiding cystourethrogram, ultrasound, intravenous urogram, an d nuclear renal scan was used to assess anatomy and function. Ablation of the involved segment was carried out if no or extremely poor funct ion was identified; a definitive reconstructive procedure was elected in the face of easily measureable function. Outcome was determined cli nically and by repeat imaging. Results: There was no difference in the rate of renal segment salvage between the prenatally and clinically d iagnosed groups. Of the cases analyzed, 20/79 were prenatally identifi ed, of which 13/20 (65%) were reconstructed; 59/79 were identified on clinical grounds, of which 34/59 (58%) were reconstructed. One patient in the prenatal salvage group underwent removal of the affected kidne y 5 years later. Another, in the clinical salvage group, underwent a s uccessful secondary procedure for closure of a ureteral fistula. All o thers have shown improved function, drainage, or both in follow-up. No secondary procedures have been required for the ablation group to dat e. Follow-up ranges from 4 months to 12 years. Conclusions: Prenatal i dentification of significant duplex system hydronephrosis does not imp rove the rate of renal segment salvage, as determined by standard radi ographic means, compared to later identification an clinical grounds. The decision for reconstruction versus ablation in significant duplex system hydronephrosis can be made on the basis of function alone. (C) 1998, Elsevier Science inc. All rights reserved.