Antenatal isolated hydronephrosis associated with urinoma

Prenatal drainage of fetal urinoma with polyhydramnios: a case report and literature review

The appearance of fetal urinoma is rare in prenatal care, especially when associated with polyhydramnions. Many previous reports have concluded that the visualization of a prenatal urinoma is probably a sign of underlying renal dysplasia or poor function. Thus, the management of the reported cases, conservative treatment or uniroma drainage, has not been unified. In this paper, we present two cases of prenatally detected urinoma with prenatal drainage to improve the prognosis.

Fetal urinoma: A case report and review of the literature

Fetal urinomas are a rare but important sonographic finding. Urinomas are peri‐renal collections of urine, formed after the rupture of the kidney secondary to an underlying urinary tract obstruction or trauma. Diagnosis antenatally is important for ongoing monitoring and postnatal follow up as their presence may indicate reduced or absent kidney function in the affected kidney.

Fetal urinoma and prenatal hydronephrosis: how is renal function affected?

OBJECTIVE

In our study, the functional prognosis of kidneys with prenatal urinomas were investigated.

MATERIAL AND METHODS

Between 2006 and 2010, fetal urinomas were detected in 19 fetuses using prenatal ultrasonography (US), and the medical records were reviewed retrospectively. Of the 19 cases, the follow-up data were available for 10 fetuses. The gestational age at diagnosis, prognosis of urinomas, clinical course and renal functions were recorded. Postnatal renal functions were assessed with renal scintigraphy.

RESULTS

Unilateral urinomas and increased parenchyma echogenicity in the ipsilateral kidney were detected in all of the fetuses. Of the 10 fetuses with follow-up data, the option of termination was offered in 6 cases of anhydramnios, including 3 cases with signs of infravesical obstruction (a possible posterior urethral valve (PUV) and poor prognostic factors and 3 cases with unilateral hydronephrosis and increased echogenicity in the contralateral kidney. Only one family agreed the termination. The other 5 fetuses died during the early postnatal period. The average postnatal follow-up period in the 4 surviving fetuses was 22.5 months (8-38 months). One patient with a PUV underwent ablation surgery during the early postnatal period. In the postnatal period, none of the 4 kidneys that were ipsilateral to the urinoma were functional on scintigraphic evaluation. The urinomas disappeared in 3 cases. Nephrectomy was performed in one case due to recurrent urinary tract infections.

CONCLUSION

In our study, no function was detected in the ipsilateral kidney of surviving patients with urinomas. Upper urinary tract dilatation accompanied by a urinoma is a poor prognostic factor for renal function.