Meyer-Schwickerath M, Bedow W, Rascher W
Department of Urology, University of Essen, West-Germany.
Acta Urol Belg. 1990;58(1):39-54.
114 fetal malformations were diagnosed by ultrasound in the years 1983-1987 at our institute. 32 of these malformations involved the urinary tract. Fetuses with multicystic dysplasic kidneys and oligohydramnios have only a poor prognosis. In obstructive uropathy, however, exact antenatal diagnosis makes early leads to specific postpartal urological therapy. Modern ultrasound equipment makes it possible to localize the site of obstruction and/or dilatation in fetuses. The amount of amnion fluid indicates the degree of obstruction and is an important factor the postpartal prognosis of the children. Relieve of obstruction should be the first step of urological therapy directly after birth. We prefer to perform reconstructive surgery as soon as possible in the first 2 to 3 weeks of life. In children with subpelvic stenosis pyeloplasty is performed in the first weeks of life. Our results of 13 pyeloplasties in newborn are favourable. In children with megaureters dynamic scintigraphy or pressure flow studies (Whitaker test) are performed to diagnose or to exclude obstruction as a cause of dilatation (n = 14). In case of obstruction we perform an ureterocutaneostomy (Ring- or Sober procedure) immediately. Urethral valves causing subvesical obstruction could be treated by transvesical antegrade valve ablation, performed in 9 newborn with good success.
1983年至1987年期间，我院通过超声诊断出114例胎儿畸形。其中32例畸形累及泌尿系统。多囊性发育不良肾和羊水过少的胎儿预后较差。然而，在梗阻性尿路病中，准确的产前诊断有助于早期开展特定的产后泌尿外科治疗。现代超声设备能够定位胎儿梗阻和/或扩张的部位。羊水量可表明梗阻程度，是儿童产后预后的一个重要因素。解除梗阻应是出生后泌尿外科治疗的第一步。我们倾向于在出生后的头2至3周内尽快进行重建手术。对于盆腔下狭窄的儿童，在出生后的头几周内进行肾盂成形术。我们对13例新生儿进行肾盂成形术的结果良好。对于巨输尿管患儿，进行动态闪烁扫描或压力流研究（惠特克试验）以诊断或排除梗阻是扩张的原因（n = 14）。如果存在梗阻，我们立即进行输尿管皮肤造口术（林氏或索伯氏手术）。导致膀胱下梗阻的尿道瓣膜可通过经膀胱顺行瓣膜切除术进行治疗，9例新生儿接受该手术取得了良好效果。
