Dejter S W, Gibbons M D
Department of Surgery, Georgetown University Children's Medical Center, Washington, D.C.
J Urol. 1989 Aug;142(2 Pt 2):661-2; discussion 667-8. doi: 10.1016/s0022-5347(17)38846-8.
Antenatal hydronephrosis involving 49 renal units in 35 infants seen since 1984 was studied. Postnatal sonography performed in the first few days after birth confirmed upper tract dilatation in 39 kidneys (80 per cent) in 29 neonates and it was normal in 10 kidneys (20 per cent) in 6 neonates. Of the 6 neonates with a normal postnatal sonogram 5 underwent repeat renal sonography at an average of 2 months after birth, all showing moderate hydronephrosis (7 kidneys). Furosemide-enhanced diethylenetriaminepentaacetic acid renography was performed in 4 infants (5 kidneys) with ureteropelvic junction or megaureter obstruction, of whom 2 had persistent unilateral obstruction and underwent successful reconstructive surgery (1 pyeloplasty and 1 megaureter reimplantation). Two infants (3 kidneys) with nonobstructive dilatation are being followed while 1 infant with bilateral vesicoureteral reflux is being managed medically on long-term antimicrobial prophylaxis. Thus, 50 per cent of neonates with antenatal hydronephrosis and a normal postnatal sonogram performed during the first few days of life subsequently were found to have either significant obstruction (2 requiring surgery) or reflux. This study underscores the absolute necessity of followup sonography in all newborns with antenatal hydronephrosis that is not confirmed on the initial postnatal ultrasound.
对1984年以来收治的35例婴儿的49个肾单位的产前肾积水进行了研究。出生后头几天进行的产后超声检查证实，29例新生儿的39个肾脏（80%）存在上尿路扩张，6例新生儿的10个肾脏（20%）正常。在出生后超声检查正常的6例新生儿中，5例在出生后平均2个月时接受了重复肾脏超声检查，均显示中度肾积水（7个肾脏）。对4例（5个肾脏）存在输尿管肾盂连接部或巨输尿管梗阻的婴儿进行了速尿增强的二乙三胺五乙酸肾造影，其中2例存在持续性单侧梗阻并接受了成功的重建手术（1例肾盂成形术和1例巨输尿管再植术）。2例（3个肾脏）非梗阻性扩张的婴儿正在接受随访，1例双侧膀胱输尿管反流的婴儿正在接受长期抗菌预防的药物治疗。因此，在出生后头几天进行的产后超声检查正常的产前肾积水新生儿中，有50%随后被发现存在严重梗阻（2例需要手术）或反流。本研究强调了对所有产前肾积水且出生后首次超声检查未证实的新生儿进行随访超声检查的绝对必要性。
