Consensus on the prenatal management of antenatally detected urological abnormalities

Purpose: The incidence of an antenatally detected genitourinary abnormality is 0.5% of all pregnancies assessed, and rarely is antenatal intervention indicated. A survey of pediatric urologists was undertaken to evaluate curr ent practice patterns and recommendations regarding the need to intervene i n the antenatal period. Materials and Methods: A survey instrument was mailed to all members of the Society for Fetal Urology. There were 7 case scenarios that addressed crit ical decision points in patients with antenatally detected genitourinary ab normalities. Results: A total of 112 of 188 Society for Fetal Urology members (60%) comp leted the survey. Observation with serial ultrasound was recommended for a 32-week fetus with ureteropelvic junction obstruction. For a 36-week fetus with suspected posterior urethral valves without oligohydramnios most respo ndents elected no intervention with a minority favoring early delivery. For a 23-week fetus with suspected posterior urethral valves and oligohydramni os with normal bladder electrolytes most respondents agreed with a vesicoam niotic shunt. There was no clear consensus for a 20-week fetus with suspect ed posterior urethral valves, oligohydramnios and a nonfunctioning right ki dney. Most respondents recommended serial ultrasound to follow an 18-week f etus with suspected posterior urethral valves and normal amniotic fluid. An tenatal intervention was not recommended for a 20-week fetus with bilateral renal cystic disease, and most respondents elected no intervention for a 2 8-week fetus with a solitary kidney with suspected ureteropelvic junction o bstruction and normal amniotic fluid. Conclusions: Situations that warrant antenatal intervention for a genitouri nary abnormality are exceedingly low and may include cases of oligohydramni os, suspected favorable renal function and the absence of life threatening congenital abnormalities. In cases with normal amniotic fluid antenatal int ervention is not recommended regardless of the detected abnormality. There is an emerging trend toward early delivery of fetuses with severe genitouri nary abnormalities, normal amniotic fluid and confirmed lung maturity.