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BACKGROUND
Telemedicine is a useful modality for connecting rural patients and remote smaller urban areas to tertiary care centers. Patients are generally highly satisfied with telemedicine care. In addition, many patients would not travel significant distances for subspecialty care because of cost, weather and transportation issues.
The ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) Program is a robust telemedicine network that encompasses the entire state of Arkansas. 28 telemedicine sites are connected to the University of Arkansas for Medical Sciences, centrally located in Little Rock.
Telemedicine is used commonly in Obstetrics, especially prenatal diagnosis. Recently, we have started expanding the telemedicine capability to subspecialty prenatal consultations, including Urology. This study describes the first case series of prenatal Urologic consultations performed with telemedicine.
METHODS
Tertiary level prenatal diagnosis is managed through the Arkansas Genetics program. Fetal anomalies are recorded in the Arkansas Fetal Diagnosis and Management program database and are routinely assessed. All patients with identified anomalies are entered into this database with care coordination conducted by a case manager. In this study, the database was queried for all urologic anomalies managed from 2012 to present performed using telemedicine consultation. Pre and post natal records were reviewed for diagnoses and management plans.
Records were specifically reviewed to compare prenatal and postnatal diagnoses and management plans. When possible, prenatal and postnatal ultrasound reports were reviewed to confirm the listed diagnoses.
RESULTS
21 patients were identified who received prenatal urology consultations via telemedicine. Currently, 19 of patients have completed their pregnancies, and 2 are still pregnant. Fetal ultrasound and telemedicine consultation allowed for the diagnosis and management of Multicystic dysplastic kidney(s) in 7 patients, duplicated collecting systems in 2 patients, hydronephrosis in 11 patients, and ureterocele in 1 patient. One prenatal diagnosis of massive hydronephrosis was actually a duplicated collecting system, and one diagnosis of a poorly visualized cystic kidney was actually an absent kidney.
All patients with completed pregnancies had postpartum follow up with either a pediatrician or urologist, as recommended prenatally. All patients except one were able to deliver at their local hospital, and then undergo neonatal transport to
Arkansas Children’s Hospital. The one patient who required delivery at the University of Arkansas for Medical Sciences had a fetus affected with imperforate anus which required immediate postnatal transport to Arkansas Children’s Hospital with subsequent management there.
CONCLUSIONS
Telemedicine is a powerful tool that allows the extension of subspecialty tertiary care medicine to rural locations and remote smaller urban areas that would not otherwise have access to this level of care. Our case series demonstrates the effectiveness of this process, by allowing patients who might otherwise have not been able to travel for subspecialty consultation, an opportunity to receive prenatal consultation. We believe that telemedicine is an ideal tool for prenatal consultation with many potential benefits for the patient and healthcare team.