Analizar la evolución de la ectasia piélica neonatal y su asociación con reflujo vesicoureteral u otras anomalías del tracto urinario.

Análisis retrospectivo de 255 niños (205 varones y 50 mujeres), con ectasia piélica diagnosticada por ecografía en el primer mes de la vida. Indicación de la primera ecografía: alteración ecográfica prenatal, 150; infección urinaria, 30, y otras, 75. Clasificación en cuatro grados atendiendo al diámetro anteroposterior de la pelvis: grado I, < 1cm; grado II, 1–1,5cm; grado III, 1,6–2cm, y grado IV, > 2cm

En 153 (60%) la dilatación fue bilateral; de las unilaterales, izquierda 81,4%, y derecha, 18,6%. Grado I, 75,49%; II, 20,34%; III, 3,93% y IV, 0,24%. El tiempo medio de evolución es 32,6 ± 25,2 meses con normalización al año del 70,2% de las derechas y del 55,9% de las izquierdas, empeorando 46 (18%) entre la primera y la segunda ecografía. Se practicó cistouretrografía miccional en 203 (79,6%), y se encontraron anomalías en 50 (24,6%): 2 dilataciones uretrales y 48 reflujos vesicoureterales, sin correlación entre reflujo y grado de la ectasia (74% con diámetro anteroposterior [DAP] ≤ 1cm). El 24,3% han presentado infección urinaria. Intervenciones quirúrgicas: ocho pieloplastias, cuatro reimplantaciones ureterales y dos resecciones de válvulas uretrales tipo III.

La ectasia piélica neonatal predomina en varones (4:1) y en el riñón izquierdo en ambos sexos. Se asocia a reflujo vesicoureteral en el 23,64% sin correlación entre grado de dilatación y presencia y/o grado de reflujo, por lo que parece aconsejable practicar cistouretrografía miccional independientemente del grado, la lateralidad y el sexo.

To analyze the outcome of neonatal pelvic ectasia (PE) and the association between this entity and vesicoureteral reflux and/or other urinary tract abnormalities.

We performed a retrospective study of 255 children (205 boys, 50 girls) with an ultrasonographic diagnosis of PE in the first month of life. The initial ultrasonographic examination was indicated by urinary tract infection in 30 neonates, abnormalities in the prenatal ultrasonographic examination in 150 and by other reasons in 75. Pelvic ectasia was classified in four stages according to antero-posterior pelvic diameter: I < 1cm, II 1–1.5cm, III 1.6–2cm, and IV > 2cm

Pelvic ectasia was bilateral in 153 children (60%) and unilateral in 102 (left side in 81.4% and right side in 18.6%). Stage I was found in 75.49%, stage II in 20.34%, stage III in 3.9% and stage IV in 0.24%. The mean follow-up was 32.6 ± 25.2 months. At the end of the first year, the results of renal ultrasound were normal in 70.2% of left-sided PE and in 55.9% of right-sided PE, but 46 patients (18%) showed worsening of PE between the first and second ultrasound scans. Voiding cystourethrography was performed in 79.6% of the children and some abnormalities were found in 50 (24.6%): urethral dilatations in two patients and vesicoureteral reflux in 48. No correlation was found between vesicoureteral reflux and the degree of ectasia (74% had an anteroposterior diameter of ≤ 1cm). Urinary tract infection was present in 24.3% of the children and 13 required surgery (eight pyeloplasties, four urethral reimplantations and two resections of type III urethral valves).

Neonatal PE was more prevalent in boys (4:1) and was more frequently located on the left side in both sexes. Associated vesicourethral reflux was found in 23.64% with no correlation between the degree of dilation and the presence or degree of reflux. Consequently, cystourethrography should be performed in any child with pelvic ectasia, regardless of stage, side or sex.