Today most of the problems of the urinary tract are diagnosed before birth.
Pregmant women systematically are examined by ultrasounds done by specialized gynecologists.
The most important ultrasound for the urinary tract is called “B level” which is done from 18 to 23 weeks of gestation. From the middle of the fifth month of pregnancy, the urinary system is already completely formed and functional. The fetus drinks large amounts of amniotic fluid and urinates in cycling. The lack of amniotic fluid very often corresponds to renal failure of the fetus.
Most urinary problems are diagnosed by urinary retention in the kidneys (hydronephrosis).
In these cases, when the amniotic fluid is normal quantity, there is no reason to panic. Most diagnoses correspond to small problems that do not affect the functioning of the kidneys and resolve themselves with the development fo the child.
If the problem is only in one kidney , even for high degree of hydronephrosis, is not considered important, knowing that at worst, one kidney is enough for you to live a normal human life. Sometimes the examiner discovers the existence of only one kidney. If the problem is in both kidneys and important, need to be a serious assessment of the parenchyma (functional piece of kidney) the drainage tract (ureters, bladder and urethra) and of course the amniotic fluid. In those cases the opinion of the pediatric urologist is very important. In cases of doubt, the pregnant woman should be referred to highly specialized gynecologists, sonographers, who only deal with prenatal diagnosis. Even if you do not have a diagnosis of abnormalities of the urinary tract in the “B level” ultrasound, the examiner in ultrasound-doppler of the 30th to 32nd
weeks, must still examine the kidneys, because the problems can be seen later in pregnancy.
When there is a diagnosis in the “B level” or doppler, there should be ultrasound every four weeks until the end of pregnancy. The worst problems until the end of pregnancy are relatively rare and somewhat more of the cases of disappearance of the problems until the child is born. The ultrasound of the newborn sould not be done unless there are serous problems the first two days of life because the newborn is dried and it can “hide” real problems.
Rarely we are forced to take the child before the normal end of pregnancy. In very few cases also suggest the termination of pregnancy, when we are confident that problems will lead the child to renal failure of that the quality of life will be poor. For both these decisions, the opinion of the pediatric urologist is necessary, who can appreciate the gravity of the situation.
After the birth, the pediatric urologist takes care of the child and decides if the baby needs, in small doses, antibiotic therapy to protect against urinary tract infections and if necessary additional tests such as cystography, scan kidneys, intravenus pyelogram etc.
Roughly 12% of prenatal diagnoses corresponding to vesicorenal reflux and 88% to stenoses of the urinary tract that can exist on different floors of the urinary system. The consolation is that far more cases, both the vesicorenal reflux and the stenosis (obstruction) of the urinary tract, automatically disappear with the development of the child alone, without the help of surgery.
Prenatal diagnosis brought revolution in the world of pediatric urology. The children do not have time to make UTI (pyelonephritis), which can damage the kidney.
Such interventions in children are now been simplified enough and experienced hands at highest success rates.
