Abstract

ALCONCHER, Laura; TOMBESI, Marcela  and  ARGUMEDO, Alejandro. Historia natural de la hidronefrosis antenatal leve: Controversias en su manejo. Arch. argent. pediatr. [online]. 2004, vol.102, n.4, pp.259-264. ISSN 0325-0075.

Introduction. Whether the cystourethrography should be performed in every patient with antenatal hydronephrosis regardless the magnitude of postnatal hydronephrosis remains unclear. Objectives. 1) To determine the percentage of newborns with mild postnatal hydronephrosis and 2) to determine the incidence of urinary tract infection and outcome of two groups of patients managed with different approaches. Population, material and methods. Between 1989 and 2003, 150 newborns with antenatal hydronefrosis were studied by renal and vesical ultrasound. Newborns with small and echogenic kidneys, renal duplication, hydroureteronephrosis, bladder abnormalities and severe, moderate and bilateral hydronephrosis were excluded based on postnatal echographic results. Two groups of patients managed prospectively with two different protocols were analyzed retrospectively: Group A) neonates on antibiotic prophylaxis, studied by cystourethrography, in whom reflux incidence was determined. Group B) neonates followed up with neither antibiotic prophylaxis nor cystourethrography. Seventy four had a mild postnatal hydronephrosis, there was no follow-up in 4 patients, 23 were in Group A and 47 in Group B. Both groups had clinical and ultrasound follow-up every 3 months. Results. Mild postnatal hydronephrosis was found in 49.3%. Reflux was detected in 3 patients in group A. Only one patient in this group had urinary infection and his cystourethrography was normal. Of the 47 patients in group B, 4 (8.5%) had a symptomatic infection; the cystourethrography showed a grade I reflux in one patient and a bladder diverticulum in another. Hydronephrosis involuted in 80 and 78% of the cases in groups A and B respectively. Conclusions. Half of the postnatal hydronephroses were mild. The difference in the incidence of urinary tract infection was not statistically significant between the groups with and without antibiotic prophylaxis. Thirteen percent of the patients in group A had a low grade reflux. Hydronephrosis involuted in 3/4 of the cases in both groups and to date, no patient has shown progression.

Keywords : Mild antenatal hydronefrosis; Voiding cystourethrography; Urinary infection; Antibiotic prophylaxis; Outcome.

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