Mandell J, Peters C A, Retik A B
Department of Surgery, Children's Hospital, Boston, Massachusetts.
Urol Clin North Am. 1990 May;17(2):247-62.
Perinatal urology has become a significant facet of pediatric urologic practice. This article reviews the approaches to the diagnosis of prenatal hydronephrosis and its typical sonographic appearances in relation to the underlying pathology. A review of the outcomes of prenatal uropathology serves as a basis on which to interpret reports of prenatal intervention for hydronephrosis. A critical review of the experience of prenatal intervention is conditionally supportive of its benefits, but this view must be tempered by a recognition of the inherent risk to the mother and fetus. Included within this view is a recognition that not all hydronephrosis is caused by obstruction. More specific prognostic indicators of renal and pulmonary functional reserve are critically needed to permit appropriate patient selection. This must be coupled with more rigorous assessment of outcomes and complete reporting of the results. Continued basic and clinical research is important in developing these data. A management strategy for hydronephrosis in the prenatal and postnatal periods is presented, based on the goal of permitting maximal renal as well as pulmonary development in utero and in the newborn period.
围产期泌尿学已成为小儿泌尿学实践的一个重要方面。本文回顾了产前肾积水的诊断方法及其与潜在病理相关的典型超声表现。对产前泌尿病理学结果的回顾为解释产前肾积水干预报告提供了基础。对产前干预经验的批判性回顾有条件地支持其益处，但这种观点必须因认识到对母亲和胎儿的固有风险而有所缓和。这种观点还包括认识到并非所有肾积水都是由梗阻引起的。迫切需要更具体的肾和肺功能储备预后指标，以便进行适当的患者选择。这必须与对结果进行更严格的评估以及完整报告结果相结合。持续的基础和临床研究对于生成这些数据很重要。基于在子宫内和新生儿期允许最大程度的肾脏和肺部发育这一目标，提出了产前和产后肾积水的管理策略。
