Montemarano H, Bulas D I, Rushton H G, Selby D
Department of Diagnostic Imaging and Radiology, Children's National Medical Center, The George Washington University Medical Center, Washington, DC 20010-2970, USA.
J Ultrasound Med. 1998 Dec;17(12):743-9. doi: 10.7863/jum.1998.17.12.743.
The objective of this paper was to determine if prenatal sonographic findings can accurately differentiate between the causes of bladder distention and pyelectasis in the male fetus. Twenty-one cases were evaluated for the presence of oligohydramnios, posterior urethral dilation, bladder wall thickening, urachal patency, cortical thinning, cortical cysts, and increased renal echogenicity. Postnatal diagnosis included posterior urethral valves (10 cases), prune belly syndrome (four cases), vesicoureteral reflux (four cases), left ureterovesical junction obstruction (one case), and nonrefluxing, nonobstructive megacystis-megaureter (two cases). Oligohydramnios was present in eight of 10 cases of posterior urethral valves and in one of four cases of prune belly syndrome. A dilated posterior urethra was noted in seven of 10 cases of posterior urethral valves and transiently in two of four cases of prune belly syndrome. Bladder wall thickening developed in all cases of posterior urethral valves and was noted in two of four patients with prune belly syndrome. A patent urachus likewise was identified in two of four cases of prune belly syndrome. The presence of oligohydramnios, progressive bladder wall thickening, and dilated posterior urethra was most suggestive of posterior urethral valves, whereas the presence of a patent urachus was most suggestive of prune belly syndrome. The presence of pyelectasis and megacystis without additional amniotic fluid, bladder, urethral, or renal abnormalities was most suggestive of vesicoureteral reflux, ureterovesical junction obstruction, or nonrefluxing, nonobstructive megacystis-megaureter. Owing to the overlap and evolution of these findings, close follow-up evaluation is recommended.
本文的目的是确定产前超声检查结果能否准确区分男性胎儿膀胱扩张和肾盂积水的原因。对21例病例评估了羊水过少、后尿道扩张、膀胱壁增厚、脐尿管通畅、肾皮质变薄、皮质囊肿以及肾回声增强的情况。产后诊断包括后尿道瓣膜症（10例）、梅干腹综合征（4例）、膀胱输尿管反流（4例）、左输尿管膀胱连接处梗阻（1例）以及非反流性、非梗阻性巨膀胱-巨输尿管（2例）。10例后尿道瓣膜症患者中有8例存在羊水过少，4例梅干腹综合征患者中有1例存在羊水过少。10例后尿道瓣膜症患者中有7例可见后尿道扩张，4例梅干腹综合征患者中有2例短暂出现后尿道扩张。所有后尿道瓣膜症病例均出现膀胱壁增厚，4例梅干腹综合征患者中有2例出现膀胱壁增厚。4例梅干腹综合征患者中有2例同样发现脐尿管通畅。羊水过少、进行性膀胱壁增厚以及后尿道扩张最提示后尿道瓣膜症，而脐尿管通畅最提示梅干腹综合征。肾盂积水和巨膀胱的存在，且无其他羊水、膀胱、尿道或肾脏异常，最提示膀胱输尿管反流、输尿管膀胱连接处梗阻或非反流性、非梗阻性巨膀胱-巨输尿管。由于这些发现存在重叠和演变，建议密切随访评估。
