| Abstract | Cilj istraživanja: Cilj ovog istraživanja bilo je vrednovati prenatalni ultrazvučni probir mokraćnog sustava postnatalnim ultrazvučnim pregledom mokraćnog sustava u djece pregledane nakon rođenja na Klinici za dječje bolesti Kliničkog bolničkog centra Split, u razdoblju od siječnja 2011. do prosinca 2015. godine.
Ispitanici i metode: Retrospektivno je pregledana dokumentacija o ultrazvučnim pregledima na Klinici za dječje bolesti KBC-a Split i arhiva povijesti bolesti 160 djece koja su poslije rođenja pregledana na Klinici, nakon što im je prenatalnim ultrazvučnim probirom otkrivena anomalija mokraćnog sustava. Uključeni su ispitanici oba spola. Iz studije su isključeni ispitanici čiji su podaci bili nepotpuni (n=15). Analizirani su spol, prenatalna ultrazvučna dijagnoza, postnatalna ultrazvučna dijagnoza, neposredno nakon rođenja uredni ultrazvučni nalazi koji su tijekom praćenja postali pozitivni, te tijek bolesti s obzirom na potrebu za kirurškim liječenjem ili ultrazvučnim praćenjem. Prenatalni ultrazvučni nalazi su uspoređivani s postnatalno postavljenom dijagnozom, te poduzetim operacijskim zahvatima.
Rezultati: U izabranom studijskom razdoblju istraživanje je obuhvatilo 160 bolesnika, od kojih 39 djevojčica (24%) i 121 dječak (76%). Najčešća prenatalno dijagnosticirana anomalija bila je hidronefroza (83,1%). Specifičnost prenatalnog ultrazvučnog probira anomalija mokraćnog sustava bila je 35%. Kod 65% ispitanika prenatalnim probirom postavljena je netočna dijagnoza, pritom kod 43% (n=69) ispitanika anomalije evidentirane prenatalno nisu prisutne poslije rođenja, a kod njih 22% (n=35) prenatalno nije otkrivena točna anomalija koja je dijagnosticirana postnatalno. Među patološkim postnatalnim nalazima najčešća je bila hidronefroza (31,8%). 83,1% djece je u daljnjem tijeku zahtijevalo samo ultrazvučno praćenje, 16,3% djece je kirurški liječeno, a u 1 slučaju (0,6%) zabilježen je smrtni ishod. Od kirurški liječenih ispitanika, kod njih 46% je točna dijagnoza postavljena prenatalno, te je u ovoj skupini najčešća intervencija bila postavljanje „Double J“ proteze, dok je kod njih 54% točna dijagnoza postavljena tek ultrazvučnim pregledom nakon rođenja i u ovoj skupini djece najčešće poduzeta intervencija bila je elektroresekcija valvule stražnje uretre.
Zaključci: Svako dijete kojem je prenatalno postavljena sumnja na postojanje anomalije mokraćnog sustava treba nakon rođenja biti ultrazvučno pregledano. U 35% slučajeva ovo istraživanje je pokazalo potpuno podudaranje prenatalnog i postnatalnog ultrazvučnog nalaza mokraćnog sustava. Prenatalni i postnatalni ultrazvučni pregled se nadopunjuju i važno ih je kombinirati kako bi se postigla visoka stopa otkrivanja anomalija mokraćnog sustava u novorođenčadi. |
| Abstract (english) | Diploma thesis title: Evaluation of prenatal ultrasound screening of the urinary tract by postnatal ultrasound examination of the urinary tract.
Objectives: The aim of this study was to evaluate the prenatal ultrasound screening of urinary tract by postnatal ultrasound examination of the urinary tract in children examined after birth at the Department of Pediatrics, Split University Hospital, in the period from January 2011. to December 2015.
Patients and Methods: We retrospectively reviewed the documentation of ultrasound examination at the Department of Pediatrics, Split University Hospital, and medical history of 160 children who were examined after birth at the Department, after their prenatal ultrasound screening detected anomalies of the urinary system. Patients of both genders were included. The study excluded patients whose data were incomplete (n=15). The gender, prenatal ultrasound diagnosis, postnatal ultrasound diagnosis, ultrasound findings that have became positive during follow-up, and further course due to the need for surgical treatment or ultrasound monitoring were analyzed. Prenatal ultrasound findings were compared with postnatal diagnosis, and undertaken surgical procedures.
Results: In the current study period, the study included 160 patients, of which 39 were girls (24 %) and 121 boys (76%). The most common prenatally diagnosed anomaly was hydronephrosis (83,1%). The specificity of prenatal ultrasound screening for anomalies of the urinary system was 35%. Incorrect prenatal diagnosis was set in 65% of patients, while among them 43% (n=69) of anomalies recorded prenatally were not present at birth, and 22% (n=35) of them were postnatally diagnosed with different anomaly than prenatally. The most common postnatal pathological finding was hydronephrosis (31,8%). 83,1% of children in the further course required only ultrasound monitoring, 16,3% of children were treated surgically, and one child (0,6%) died. Prenatal diagnosis was accurate in 46% of all surgically treated children, and in this group the most frequent intervention was endoscopic implantation of "Double J" prosthesis, while in 54% of cases truely correct diagnosis was made by ultrasonography after birth, and in this group of children the most common intervention was electroresection of posterior urethral valves.
Conclusions: Each newborn with the existence of prenatally suspected anomaly of the urinary system, should be sonographically examined after birth. In 35% of cases, postnatally diagnosed abnormalities coincided with the prenatally discovered fetal urogenital developmental disorders. The combination of prenatal and postnatal ultrasound screening is an important way to achieve a high detection rate of congenital anomalies of urinary tract in newborns. |
