Perinatal Urinary Tract Dilation: Recommendations on Pre-/Postnatal Imaging, Prophylactic Antibiotics, and Follow-up: Clinical Report
C. D. Anthony Herndon, Hansel J. Otero, David S. Hains, Rebecca M. Sweeney, Gina Lockwood, Section on Urology, Nicholas G. Cost, Stephen Canon, Gregory Dean, Martin Kaefer, Kathleen Kieran, Andrew J. Kirsch, John C. Pope, Section on Nephrology, Vikas R. Dharnidharka, Donald L. Batisky, Daniel I. Feig, Juan C. Kupferman, Kimberly J. Reidy, Carol Shen, Douglas M. Silverstein, Section on Radiology, Hansel J. Otero, Patricia T. Acharya, Adina Alazraki, Ellen Benya, Brandon P. Brown, Reza Daugherty, Sarah Sarvis Milla, Geeta Singhal, Rachel Marek, H. Barrett Fromme, Jessica M. Allan, Zoey Goore, Laura Nell Hodo, Dimple Khona, Tony Tarchichi, Jorge Ganem, Eleanor Sharp
Abstract
Perinatal urinary tract dilation (UTD) occurs in approximately 1% of all pregnancies and represents the second most common congenital anomaly detected prenatally, second only to cardiac defects. Causes of UTD include transient dilation, vesicoureteral reflux (VUR) and genitourinary obstruction. A vast majority of these conditions will never require surgical intervention. However, a subset of patients will be at increased risk of urologic and kidney disease. The purpose of this clinical report will be to review the current imaging modalities used for the evaluation of perinatal UTD and discuss the risk stratification for UTD, the indications for prophylactic antibiotics, and the use of lower tract imaging and renal scintigraphy (RS). Ultimately, the management of these children is individualized and should involve a shared-decision making process between the physician and parent/guardian that is evidence based. The evaluation and management of more severe forms of bilateral UTD in boys who are at high risk for bladder outlet obstruction is outside of the scope of this document. Any concern for this entity should prompt an immediate consultation with a nephrology/urology specialist.