Prenatal diagnosis of ureteroceles

Abstract The ability to view the fetus in its intrauterine environment with ultrasound imaging has revolutionized obstetric care and prompted the development of the concept of “the fetus as a patient,” enabling antenatal fetal diagnoses and direct fetal therapy. In developed countries, the standard of obstetric care incorporates sonographic fetal anatomic survey into routine antenatal care. Insights into development and natural history of renal tract anomalies have been facilitated by technological developments in obstetric ultrasound imaging and the incorporation of routine ultrasound imaging protocols into structural evaluation of every fetus. Published clinical practice guidelines for obstetric imaging specialties provide direction for imaging standards of the fetal renal tract. Formerly limited to examination of the fetus in the second and third trimesters, obstetric imaging of the fetus has been extended into the first trimester as an integral part of established aneuploidy screening programs. First trimester imaging of the fetus has provided the opportunity for early structural survey of the fetus. This has enabled the early detection of fetal renal anomalies, informed parental counseling around fetal renal diagnoses and facilitated early, antenatal referral of affected fetuses and their parents to Maternal Fetal Medicine specialists and Pediatric Urologists for consideration of fetal or neonatal therapy. This chapter will chronicle the development of the fetal urinary tract viewed sonographically, outline the imaging features characterizing antenatal diagnosis of ureteroceles, highlight the differential diagnosis of this condition, and provide insights into in utero options for prenatal management.