Prenatal diagnosis of urinary malformations: results in a series of 93 consecutive cases

Objective: to evaluate the pertinence of prenatal diagnosis in cases of con genital uropathy. Study design: retrospective evaluation over a period of 6.5 years. Method: 93 cases were involved in the comparison of prenatal ultrasonograph ic diagnosis with neonatal findings, autopsy results, and follow-up data. Results: 33 fetuses had renal parenchymal lesions, 44 had excretory system lesions, and 6 had bladder and/or urethral lesions. Seventy-three pregnanci es lead to live births. Eighteen terminations of pregnancy were performed o n the parents' request for extremely severe malformations. Two intrauterine deaths were observed, and two infants died in the postnatal period. Prenat al diagnosis was obtained at an average of 27 weeks' gestation. Diagnostic concordance was excellent in 82% and partial in 12% of cases with renal par enchymal lesions; the false-positive rate was 6%. For excretory system lesi ons, concordance was excellent in 87% and partial in 7.4% of cases, with a false-positive rate of 5.6%. Finally, concordance was excellent in 100% of cases of bladder and/or urethral lesions. The overall rate of total concordance was 86%. Partial concordance cases co nsisted of malformations different front those previously diagnosed, but pr enatal diagnosis nevertheless lead to further investigations in the neonata l period and to proper management. The false-positive diagnoses (5.4%) neve r lead to termination of pregnancy. Conclusion: prenatal diagnosis of congenital uropathy is effective. A third -trimester ultrasonographic examination is necessary to ensure proper neona tal management, considering that the majority of cases are diagnosed at thi s gestational age.