Perinatal Urinary Tract Dilation Clinical Pathway — ICU, Inpatient, Outpatient Specialty Care, Primary Care

Patient Cohort

This pathway should be used to guide the evaluation and management of neonates presenting with ultrasound findings of perinatal urinary tract dilation (UTD).

This pathway should be used by neonatal providers (pediatricians, neonatologists, urologists, etc.) to guide risk-based evaluation and treatment based on prenatal and postnatal ultrasound findings.

Background on UTD

It is estimated that 1% to 5% of all pregnancies will have findings of antenatal urinary tract dilation (UTD). The etiology of antenatal UTD is varied and includes: ureteropelvic junction (UPJ) obstruction, vesicoureteral reflux (VUR), lower urinary tract obstruction (posterior urethral valves, ureterocele, urethral atresia), and idiopathic transient dilation.

UTD can be followed by US in the pre- and postnatal periods. By the first prenatal ultrasound (generally around 20 weeks) the renal architecture is visible and UTD can be detected. However, the management of postnatal UTD following an antenatal diagnosis is controversial. The debate centers on timing of initial and follow-up imaging with renal and bladder ultrasound (RBUS), prescribing prophylactic antibiotics and use of voiding cystourethrogram (VCUG) and contrast-enhanced voiding urosonography (ceVUS) to assess for vesicoureteral reflux (VUR) and bladder outlet obstruction.

This pathway is meant to provide clinical decision support and recommendations are adapted from the 2014 multidisciplinary consensus of urinary tract dilation risk stratification and CHOP Urology consensus.

References

Nguyen, Herndeon, Cooper. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Perinatal Urinary Tract Dilation Clinical Pathway — ICU, Inpatient, Outpatient Specialty Care, Primary Care

Patient Cohort

Background on UTD

References

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Innovation and your child

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Perinatal Urinary Tract Dilation — Patient Cohort — Clinical Pathway: Inpatient, Outpatient Specialty Care and Primary Care

Perinatal Urinary Tract Dilation Clinical Pathway — ICU, Inpatient, Outpatient Specialty Care, Primary Care

Patient Cohort

Background on UTD

References