Mouriquand P, Mollard P, Ransley P
Service d'urologie pédiatrique de l'hôpital Debrousse, Lyon, France.
Pediatrie. 1989;44(5):357-63.
The early ultrasound detection of fetal urinary dilatations raises dilemmas about their physiological and pathological meanings. Dilatation does not always mean pathological obstruction of the urinary tract. The chronology of the embryology of the Wolffian system is partially unknown and some hypotheses can be developed concerning the urine drainage in the fetus. The physiology of the fetal kidney is also unclear because of the inadequacy of the functional assessments and their dependence on the mother's parameters. The study of the pressures inside the different segments of the fetal urinary tract could be an efficient tool in the understanding of its progressive permeabilization. The difference between primary kidney dysgenesis and kidney dysplasia secondary to urine hyperpressure appears to be of paramount importance in the fetal treatment of these dilatations and in the long-term prognosis. Thus one can better understand how difficult the decision of shunting the fetal urine toward the amniotic cavity. Can be no one can prove its benefit for the fetal development and some lethal complications of these in utero procedures have been described. However, this new approach of the fetal urinary tract obstruction leads us to a change in the therapeutic attitudes in newborns, which stresses a better understanding of this development.
胎儿泌尿系统扩张的早期超声检测引发了关于其生理和病理意义的诸多难题。扩张并不总是意味着泌尿系统存在病理性梗阻。中肾系统胚胎发育的时间顺序部分尚不明确，因此可以提出一些关于胎儿尿液引流的假说。由于功能评估的不足及其对母体参数的依赖，胎儿肾脏的生理学也尚不清楚。研究胎儿泌尿系统不同节段内的压力可能是理解其逐渐通透的有效工具。原发性肾发育不全与继发于尿液高压的肾发育异常之间的差异，在这些扩张的胎儿治疗及长期预后方面似乎至关重要。因此，人们能够更好地理解将胎儿尿液分流至羊膜腔这一决策有多困难。没有人能够证明其对胎儿发育有益，并且已经描述了这些宫内操作的一些致命并发症。然而，这种针对胎儿泌尿系统梗阻的新方法促使我们改变对新生儿的治疗态度，这强调了对这一发育过程的更好理解。
