Silveri M, Adorisio O, Pane A, Zaccara A, Bilancioni E, Giorlandino C, De Gennaro M
Department of Pediatric Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
Pediatr Med Chir. 2002 Sep-Oct;24(5):394-6.
The "fetal urinoma" is a clinical and diagnostic entity due to urinary extravasation, early diagnosed in fetal and/or neonatal period. Both urinoma and urinary ascites, whose pathogenesis is not clear, are recognized associations of uterero-pelvic junction obstruction (UPJO) and neonatal posterior urethral valves (PUV) related with a protected fetal and neonatal renal function. Clinical and experimental studies have demonstrated that fetal urinary tract obstruction results in severe renal parenchymal injury. The so called "pop-off" valve mechanism has been advocated to justify the upper tract function preservation. Protective "pop-off" mechanisms, such as a unilateral reflux and dysplasia, urinary extravasation and congenital bladder diverticula are present in about 30% of patients with PUV. Their presence correlates with better overall long-term renal function. This mechanism has been justified as a sort of self derivation, to explain the renal function preservation in fetal and neonatal period. In the last two years we observed three cases of fetal monolateral urinoma, prenatally detected in fetuses with diagnosis of PUV. All three cases did well for that concerning renal function despite some current opinions suggesting the necessity of a bilateral urinary extravasation in order to preserve upper urinary tract function.
“胎儿尿瘤”是一种因尿液外渗导致的临床和诊断实体，在胎儿期和/或新生儿期可早期诊断。尿瘤和尿腹水的发病机制尚不清楚，它们是输尿管肾盂连接部梗阻（UPJO）和新生儿后尿道瓣膜（PUV）的公认关联病症，与胎儿和新生儿肾功能的保护有关。临床和实验研究表明，胎儿尿路梗阻会导致严重的肾实质损伤。所谓的“安全阀”机制被认为可以解释上尿路功能的保留。约30%的PUV患者存在保护性“安全阀”机制，如单侧反流和发育异常、尿液外渗和先天性膀胱憩室。它们的存在与更好的长期整体肾功能相关。这种机制被认为是一种自我衍生，以解释胎儿期和新生儿期肾功能的保留。在过去两年中，我们观察到3例胎儿单侧尿瘤，产前在诊断为PUV的胎儿中检测到。尽管目前一些观点认为需要双侧尿液外渗以保留上尿路功能，但所有这3例患者的肾功能都良好。
