Аntenatal diagnosis and application of fetal surgery methods for obstructive uropathies

Abstract

Obstructive uropathies are a group of diseases characterized by an impairment of the normal outflow of urine through the urinary tract, which can cause serious pathologies in newborns and infants. The use of minimally invasive and widely available diagnostic methods, such as ultrasound, is essential for establishing a correct diagnosis and choosing the optimal management strategy for pregnancy. The aim of this review is to conduct a comprehensive analysis of the possibilities of prenatal diagnosis, prognostic criteria, and modern methods of intrauterine treatment of obstructive uropathies to improve perinatal outcomes. A systematic review of fetal ultrasound and magnetic resonance imaging data was conducted, an assessment of the effectiveness of classification systems (SFU, UTD), and an analysis of the results of intrauterine interventions (vesico-amniotic shunting, fetal cystoscopy, nephro-amniotic shunting). 
Antenatal hydronephrosis occurs with a frequency of 1:750–1:1500, with 50–70% of cases being transient. Key prognostic criteria include: pelvic diameter ≥15 mm, bilateral involvement, oligohydramnios, hyperechogenicity of the parenchyma, and the presence of cystic changes. Modern methods of prenatal diagnosis allow for the timely detection of critical forms of obstructive uropathies. Prenatal ultrasound demonstrates a sensitivity of 78–91%; however, in complex cases, it needs to be supplemented with magnetic resonance imaging (sensitivity up to 92%). Intrauterine interventions (shunting, cystoscopy) increase perinatal survival by 20–30%, but their impact on long-term renal function remains a subject of debate. A multidisciplinary approach, including dynamic monitoring, specialist consultations, and antenatal interventions, can significantly improve perinatal outcomes. However, further research aimed at evaluating the long-term results of intrauterine treatment and developing new minimally invasive technologies is necessary to optimize management strategies.