Barış SEVER, Halil Gürsoy PALA, Ceren GÖLBAŞI, İbrahim ÖMEROĞLU, Hakan GÖLBAŞI, Elif UÇAR

FETAL GENİTOÜRİNER ANOMALİLERİN ULTRASONOGRAFİK TANISI: TERSİYER MERKEZDE RETROSPEKTİF ANALİZLERİ

Giriş: Çalışmamızda kliniğimize fetal tarama amaçlı başvuran gebelerde tespit ettiğimiz genitoüriner sistem anomalilerinin dağılımını sunmayı amaçladık. Gereç ve Yöntem: Son 4 yılda Tepecik Eğitim ve Araştırma Hastanesi Perinatoloji polikliniğimize başvuran 81163 gebenin verileri hastane dijital arşivinden ve hasta dosyalarından retrospektif olarak incelendi. Genito üriner sistem (GÜS) anomalisi tespit edilen 276 gebe çalışmamıza dahil edildi. Bulgular: Çalışmamızda renal malformasyonlar en sık tespit edilen anomaliler olarak bulundu. Böbreğin gelişimsel varyasyonları ve genital patolojiler en sık 2. anomali olarak izlendi. Vakalar analiz edildiğinde, renal malformasyon görülen vakalarda ise en sık multikistik displastik böbrek izlenmiştir. Gelişimsel varyasyonlar ve genital patolojiler görülen vakalarda is en sık olarak posterior üretral valv ve over kisti bulunmuştur. Sonuç: Genitoüriner sistem anomalileri başka anomalilerle de birliktelik gösterebildiğinden genel sistem taraması ayrıntılı yapılmalıdır. Erken tanı sayesinde gebeliğin gidişatı belirlenebilmektedir.

ULTRASOUND DIAGNOSIS OF FETAL GENITOURINARY ANOMALIES: RETROSPECTIVE ANALYSES IN A TERTIARY CENTER

Introduction: To present the distribution of genitourinary system anomalies that we detected in pregnant women who applied for fetal ultrasound scanning. Materials and Methods: The data of 81163 pregnant women who applied to our Tepecik Training and Research Hospital Perinatology clinic in the last 4 years were retrospectively analyzed from the hospital digital archive and patient files. 276 pregnant women with genito urinary system anomaly (GUS) were included in our study. Results: In our study, renal malformations were found to be the most common anomalies. Developmental variations of the kidney and genital pathologies were the second most common anomaly. When the cases were analyzed, multicystic dysplastic kidney was most frequently observed in cases with renal malformation. In cases with developmental variations and genital pathologies, posterior urethral valve and ovarian cysts were found most frequently. Conclusion: Since genitourinary system anomalies can be associated with other anomalies, ultrasound screening should be done in detail. With early diagnosis, the prognosis of pregnancy can be determined.

PDF

___

1. Queisser-Luft A, Stolz G, Wiesel A, Schlaefer K, Spranger J. Malformations in newborn: results based on 30,940 infants and fetuses from the Mainz congenital birth defect monitoring system (1990-1998). Arch Gynecol Obstet 2002; 266(3): 163–7.
2. Wiesel A, Queisser-Luft A, Clementi M, Bianca S, Stoll C, EUROSCAN Study Group. Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: an analysis of 709,030 births in 12 European countries. Eur J Med Genet 2005; 48(2): 131–44.
3. Freedman AL, Bukowski TP, Smith CA, Evans MI, Johnson MP, Gonzalez R. Fetal therapy for obstructive uropathy: diagnosis specific outcomes [corrected]. J Urol 1996; 156(2 Pt 2): 720–3; discussion 723-724.
4. Rosendahl H. Ultrasound screening for fetal urinary tract malformations: a prospective study in general population. Eur J Obstet Gynecol Reprod Biol 1990; 36(1–2): 27–33.
5. Passerotti CC, Kalish LA, Chow J, Passerotti AMAMS, Recabal P, Cendron M et al. The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. J Pediatr Urol 2011; 7(2): 128–36.
6. Warshaw BL, Edelbrock HH, Ettenger RB, Malekzadeh MH, Pennisi AJ, Uittenbogaart CH, et al. Renal transplantation in children with obstructive uropathy. J Urol 1980; 123(5): 737–41.
7. Tonni G, Ida V, Alessandro V, Bonasoni MP. Prune-belly syndrome: case series and review of the literature regarding early prenatal diagnosis, epidemiology, genetic factors, treatment, and prognosis. Fetal Pediatr Pathol 2013; 31(1): 13–24.
8. Rodriguez MM. Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT). Fetal Pediatr Pathol 2014; 33(5–6): 293–320.
9. James CA, Watson AR, Twining P, Rance CH. Antenatally detected urinary tract abnormalities: changing incidence and management. Eur J Pediatr 1998; 157(6): 508–11.
10. Estes JM, Harrison MR. Fetal obstructive uropathy. Semin Pediatr Surg 1993; 2(2): 129–35.
11. Yildirim ZNY. Konjenital böbrek anomalileri. Çocuk Derg 2013; 13(4): 141–6.
12. Ertekin O, Akçören Z. Urinary system malformations and associated extrarenal anomalies in perinatal autopsies. Kafkas J Med Sci 2020; 10: 32–8.
13. Bisceglia M, Galliani CA, Senger C, Stallone C, Sessa A. Renal cystic diseases: a review. Adv Anat Pathol 2006; 13(1): 26– 56.
14. Liu W, Zhang L, Ma R, Wu R. The morphology and treatment of coexisting ureteropelvic junction obstruction in lower moiety of duplex kidney. Int J Surg Lond Engl 2016; 34: 23–7.
15. Corbett ST, Burris MB, Herndon CDA. Pediatric robotic-assisted laparoscopic ipsilateral ureteroureterostomy in a duplicated collecting system. J Pediatr Urol 2013; 9(6 Pt B): 1239.e1-2.
16. Kütük MS, Doğanay S, Özdemir A, Görkem SB, Öztürk A. sonographic diagnosis of fetal adrenal hemorrhage complicating a vein of galen aneurysmal malformation. Balk Med J 2016; 33(1): 112–4.
17. Schwärzler P, Bernard JP, Senat MV, Ville Y. Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography. Ultrasound Obstet Gynecol 1999; 13(5): 351–5.
18. Demirel N, Baş AY, Zenciroğlu A, Taşci Yildiz Y. Adrenal bleeding in neonates: report of 37 cases. Turk J Pediatr 2011; 53(1): 43–7.
19. Trinh TW, Kennedy AM. Fetal ovarian cysts: review of imaging spectrum, differential diagnosis, management, and outcome. Radiogr Rev Publ Radiol Soc N Am Inc 2015; 35(2): 621–35.
20. Silva CT, Engel C, Cross SN, Copel JE, Morotti RA, Baker KE et al. Postnatal sonographic spectrum of prenatally detected abdominal and pelvic cysts. Am J Roentgenol Radium Ther 2014 ; 203(6): W684–96.
21. Lee PA, Nordenström A, Houk CP, Ahmed SF, Auchus R, Baratz A et al. Global disorders of sex development update since 2006: perceptions, approach and care. Horm Res Paediatr 2016; 85(3): 158–80.
22. Lee PA, Houk CP, Ahmed SF, Hughes IA, International Consensus Conference on Intersex organized by the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology. Consensus statement on management of intersex disorders. International Consensus Conference on Intersex. Pediatrics 2006; 118(2): e488-500.
23. Thyen U, Lanz K, Holterhus P-M, Hiort O. Epidemiology and initial management of ambiguous genitalia at birth in Germany. Horm Res 2006; 66(4): 195–203.