Introduction
Pyelectasis is a condition in which the urine accumulates in the kidneys of an unborn child. This may happen when the urine is unable to travel to the move to the bladder of the fetus due to any blockages of the urinary tract. It could occur as a result of urinary reflux. In urinary reflux, the urine may be forced to travel in a direction opposite to that of the usual pathway. Based on the region where the urine accumulation occurs, it may be called pelvocaliectasis, caliectasis, or pyelectasis.
What Is the Occurrence of Fetal Pyelectasis?
Fetal pyelectasis is a relatively common condition. It is seen in almost every 40 pregnancies. This condition can be present throughout the pregnancy or just in episodes. This condition could affect both (bilateral pyelectasis) or only one (unilateral pyelectasis) of the kidneys. Fetal pyelectasis is more common among male fetuses than female fetuses.
What Are the Causes of Pyelectasis?
Fetal pyelectasis could be caused due to two leading causes that could include:
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Vesicoureteral Reflux: Ideally, the urine, after being generated in the kidney, should move up in the ureters to the urinary bladder. It is then stored in the bladder until it is eliminated through the amniotic fluid. However, in some cases, the urine stays in the kidneys, the ureter, or the urinary bladder. If the urine fails to take its ordinary course and stays back in any of these parts, this condition is known as a vesicoureteral reflex. This condition ultimately leads to pyelectasis if the urine stays back in the kidneys, which causes swelling.
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Ureteropelvic Junction Obstruction: This is a condition in which there is a blockage in the ureter. Ureter is the tube through which the urine travels to the bladder from the kidneys. This causes the urine to remain back in the kidneys. Eventually, this may lead to pyelectasis leading to failure of the kidney.
What Is the Occurrence of Pyelectasis?
Pyelectasis is quite a common condition. This may occur in almost one in 50 cases. In pyelectasis, both or one of the kidneys may be affected. If it affects one kidney, it is known as unilateral pyelectasis. If it affects both kidneys, it is known as bilateral pyelectasis. This condition is more common in male fetuses than female fetuses.
How Serious Is Fetal Pyelectasis?
Though very common, most cases of fetal pyelectasis have very negligible effects on the growing fetus. If the pyelectasis affects only one of the kidneys, then the fetus can be born without any complications. The birth can be healthy without any complications. They also have normal developmental milestones.
Sometimes, if the pyelectasis affects both kidneys, it can cause hydronephrosis. In this case, the doctor may suggest a fetal surgery. Fetal surgery helps in removing the blockage in the ureteropelvic junction. This surgery can prevent damage to the fetus’s kidneys.
How Is Pyelectasis Different From Hydronephrosis?
Both pyelectasis and hydronephrosis are the swellings of the kidneys due to the accumulation of urine. Pyelectasis is a milder form of hydronephrosis. In hydronephrosis, there is a complete blockage of the ureter. This causes an accumulation of urine in the entire kidney leading to ballooning of the kidney. However, in pyelectasis, there is a partial blockage of the ureter. This causes enlargement only in the central portion of the kidney. Most cases of pyelectasis resolves on their own. But if the condition worsens, it can lead to hydronephrosis. This can be diagnosed by a pediatric nephrologist, and appropriate treatment can be given.
How Is Pyelectasis Related to Down Syndrome?
If pyelectasis is detected in an ultrasound scan, there is an increased chance of Down syndrome. However, this is just a chance. There may be chances of this not occurring also. To confirm this, the doctor may perform various other scans and blood tests to rule out Down syndrome. If there are no irregularities, then the child may have normal growth and development.
What Are the Symptoms of Pyelectasis, and How Is It Diagnosed?
Pyelectasis is a condition that usually does not have any symptoms. Most often, this condition is detected through routine ultrasonic investigation. This condition can be temporary or persistent. The doctor may perform investigations at regular intervals before arriving at a diagnosis. The diagnosis is achieved through means of prenatal ultrasound. If a fetus is diagnosed with pyelectasis, the doctor may perform additional monitoring during the entire duration of pregnancy.
How Is Fetal Pyelectasis Treated?
Majority of the cases of fetal pyelectasis resolves without any necessary treatment. If this condition is detected through any routine investigations, the doctor may perform routine investigations at regular intervals to check for the progress of the disease. Prenatal ultrasound can be performed at regular intervals to check for the progression of the condition.
If the condition resolves on its own, the doctor may only do regular sonographies to check for any recurrence. If the disease is of progressive nature, fetal surgery may have to be performed to remove the ductal blockage. however, fetal surgery is performed only in the rarest of cases. After the birth of the child, if the ductal blockage is persistent, the doctor may perform surgery to remove the obstruction. This procedure to remove the ductal blockage is known as pyeloplasty. This procedure or treatment is performed by a pediatric urologist or nephrologist.
What Is the Prognosis of This Condition?
If this condition is detected during a routine ultrasound, periodic rechecking is performed for constant evaluation of the condition. If left to progress, this condition may even lead to hydronephrosis. Hence regular prenatal investigations are the key to obtaining a better prognosis in this condition.
Conclusion
Fetal pyelectasis is a condition in which there is urine retention in the kidneys of a developing fetus due to any obstruction in the ureter. This can cause central swelling of the kidneys. This condition is asymptomatic and diagnosed during routine prenatal investigations. It can affect one or both kidneys. It may resolve on its own in most cases. However, early detection can aid in a better prognosis.
