The expansion of the urinary tract in children
Written by:With the increasingly widespread use of ultrasound in both prenatal and postnatal, the diagnosis of dilatation of the urinary tract has become increasingly common. The expert in Urology Pediatric in Turin, Dr.. Emilio Merlini, explains what it is
1) When it is diagnosed with a dilation of the urinary tract?
In the prenatal period, the diagnosis of urinary tract dilation affects approximately 1-2% of all pregnancies. It is usually diagnosed at the 21 th week, but they are not rare belatedly observed. The parameters that are taken into account in assessing the gravity of the situation are: the expansion of the scope, conditions of the renal tissue and early diagnosis.
Typically, the early expansion observed during pregnancy are those that require further attention after the baby is born.
2) How it is evaluated the extent of a dilation of the urinary tract?
The dilation of the entity is evaluated as antero-posterior diameter of the renal pelvis. As a rule, are considered normal expansion up to 5 mm in the second quarter and up to 10 mm at the end of pregnancy, although, of course, it is not absolute values.
It is important to note if you are also associated with an expansion of the renal calices and renal tissue abnormalities such as hyperechoic, presence of cysts or microcysts, thinning of the renal tissue or lack of differentiation parenchyma. These abnormalities worsen the prognosis of expansion with regard to future kidney function.
The expansions may affect one or both sides of the upper urinary tract (goblets and pelvis) or throughout the urinary tract "high" (goblets, pelvis and ureter). The most severe forms are usually congenital obstruction of the urethra (exclusive of the male), which lead to damage often very serious bladder, kidneys and the urinary tract.
3) What is the treatment of urinary tract dilation?
In the past, prenatal therapy of urinary tract obstruction had raised many hopes, however, were not realized. In almost all cases, the conduct of pregnancy should not be modified and the time of delivery should not be anticipated.
After birth the baby should be evaluated immediately if the suspect is an obstruction of the urethra that can endanger the patient's life. If, conversely, it is an expansion that affects so isolated a segment of the urinary tract, the infant is in good condition and urine output is normal, the assessment can be postponed for a few days and begins with an abdominal ultrasound, allowing you to confirm whether or not the prenatal diagnosis and provide anatomical details better defined.
It is best to avoid subjecting the infant to a 'ultrasound newborn, as the physiological dehydration usually postnatal causes the entity underestimation of dilation. In specific cases, where it is evident a dilatation also transient of one or two ureters, it is necessary to subject the child to cistouretrografia, examination which consists in filling the bladder with contrast medium to assess the presence or absence of a reflux vescico- ureteral. If the reflux has been excluded, usually follows the spontaneous evolution of expansion that, in a very high percentage of cases, tends to stabilize or to regress spontaneously.
The children undergo a series of urinary tract ultrasound scans that allow you to assess the worsening trend, ie the increase of the expansion or improvement of expansion. The cases with high degree of expansion, or with a tendency to deterioration or symptomatic are, after a few months, subjected to a scintigraphy with MAG3, for an evaluation of both the separate function of the two kidneys, both of the radioactive isotope excretion rate that reflects , approximately, the degree of obstruction of the urinary tract.
In general we can say that about 20-25% of all urinary tract expansions will require some form of surgery disostruttiva.
Editor Karin Moscow