Urinary Tract Anomalies

Urinary tract abnormalities account for 1450% of congenital structural abnormalities detected on antepartal ultrasonography. In view of the close embryological relationship in the development of the urinary and the genital tract, it is not surprising that renal, urethral, bladder, and genital anomalies are frequently associated. Early diagnosis with ultrasound is possible in most cases, but some do remain undetected until late pregnancy. Congenital and hereditary urinary tract abnormalities include a wide spectrum of defects ranging from gross abnormalities of morphogenesis, to more subtle disorders of renal function (renal agenesis or hypoplasia; polycystic or enlarged kidneys and; obstructive uropathy and abnormalities in adjacent abdominal organs). The fast scanning techniques of magnetic resonance imaging (MRI) have proved to be a useful supplementary imaging method without ionizing radiation in evaluating equivocal sonographic findings. Prenatal identification of genital anomalies (isolated finding: hypospadias, clitoromegaly; in combination with renal anomalies: ambiguous, micropenis, hypospadia and bifid scrotum with micropenis, no penis identified, hypospadia with chordee, clitoromegaly, cystic swelling on labia; or in combination with multiple congenital anomalies: male genitalia with bilateral multicystic ovaries, female genitalia with bowed femora, dolichocephaly, cerebral ventriculomegaly) should stimulate a detailed examination and a planned ultrasound and MRI diagnostic work-up. The urinary tract or genital abnormalities vary from minor abnormalities to severe fatal malformations. Thus, prenatal correct diagnosis is needed to make a successful decision concerning postnatal management of the fetus.