Mehmet Şükrü BUDAK, Ümit GÖRKEM, Cihan TOĞRUL, Ali Emre TAHAOĞLU, Nurgül BAŞOĞUL, Ömer BAŞOĞUL, Kerem Doğa SEÇKİN, Deniz BALSAK, Mehmet Onur KARAALTI

Üriner Sistem Anomalisi Saptanan Fetuslara Yaklaşım

Amaç: Fetal üriner sistem anomalisi saptanan olguların antenatal takibi ile yönetiminin belirlenmesi ve neonatal sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Çalışma Ocak 2004-Ocak 2005 yılları arasında Ege Doğumevi ve Kadın Hastalıkları Eğitim ve Araştırma Hastanesi’nde antenatal ultrason ile tespit edilen 57 olguyu içeriyordu. Olgular fonksiyonel böbreği olmayan Grup 1 en az bir fonksiyonel böbreği olan Grup 2 ve sadece pyelektazi izlenen Grup 3 fetuslar olmak üzere 3 gruba ayrılarak incelendi. Renal pelvis ön arka çapı ≥5 mm olan olgular pyelektazi olarak kabul edilerek çalışmaya dahil edildi. Renal pelvis ön arka çapları progresyon açısından 30. gebelik haftasından önce ve sonra değerlendirildi. Postpartum böbrek anomalili tanıları retrospektif olarak incelendi.Bulgular: Non-fonksiyonel böbrek Grup 1 nedeniyle 8 olgunun 3’ü abort ettirildi, diğer 5 fetus doğum sonrası exitus oldu. Grup 2’de yer alan 1 olgu doğum sonrası opere edildi. Unilateral ve/veya bilateral pyelektazi nedeniyle izlenen Grup 3 48 olgunun 15’inde postpartum incelemede üriner sistem anomalisi saptandı ve 11’ine operasyon uygulandı. 28 pyelektazi olgusu neonatal dönemde idrar yolu enfeksiyonu nedeniyle antibiyotik tedavisi aldı. Üç olguya prenatal dönemde amniosentez uygulandı. Bunlardan birinin gebeliği down sendromu nedeniyle sonlandırıldı. 57 olgunun 8’inde %14 anhidramniyos ve dört olguda %7 polihidramniyos tespit edildi.Sonuç: Üriner sistem anomalileri prenatal dönemde tespit edilmesi, gerek gebeliğin sonlandırılması gerekse gebeliği devam eden olgularda amniyosentez yapılması veya doğum sonrası yenidoğanın takibe alınmasında büyük öneme sahiptir. Özellikle prenatal dönemde masum gibi görünen, temelinde organik lezyon bulunan hafif renal pelvis dilatasyonları pastpartum dönemde kalıcı böbrek fonksiyon kaybı yaratmadan pediatrik üroloğa yönlendirilmelidir.

Anahtar Kelimeler:

Fetal üriner sistem anomalileri, prenatal tanı, postpartum takip

Approach To Fetuses With A Diagnosis Of Urinary System Abnormality

Aim: The aim of this prospective study was to demonstrate the management of the cases diagnosed as fetal urinary malformation at antenatal period and to compare findings to their neonatal findings.Material and Methods: This study included 57 cases who were diagnosed with antenatal ultrasound at Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital between January 2004 and January 2005. Cases were divided into group 1 with no functional kidney , group 2 with at least one functional kidney , group 3 with pyelectasia . Pyelectasia was described as anterior posterior diameter of renal pelvis to ≥5mm. Renal pelvis diameter was evaluated before and after 30 gestational week in respect to progression of pyelectasia. The data of cases who had urinary system anomalies diagnosed at postpartum period were collected retrospectively from hospital records.Results: Three of group 1’cases were aborted. Other 5 fetus died after partution. One case in group 2 was operated after partution. Urinary system abnormality was seen in 15 of 48 cases Group 3 at neonatal period. Four of them were operated. 28 cases with pyelectasia got antibiotic threapy due to urinar tract infection. Three cases underwent amniocentesis and one of them was terminated due to Down Syndrome. Chromosomal inversion was determined in other one. 8 of 57 cases 14% had anhydramnios and 4 of them 7% had polyhydramnios.Conclusion: Prenatal diagnosis of urinary system anomalies is so important for termination of pregnancy, consideration of amniocentesis for ongoing and planning neonatal follow up. The moderate pyelectasia due to organic lesion should be counselled to pediatric urology specialist for preventing kindney loss.

Keywords:

Fetal urinary system abnormality, prenatal diagnosis, postpartum follow up,

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