What is Hydronephrosis?
Hydronephrosis is swelling in the kidney due to the accumulation of urine which is not infected and it may occur due to resistance in the outflow of urine from the kidney to the ureter or urinary bladder. There are numerous potential causes of hydronephrosis, and each one needs to be addressed.
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Get A Second OpinionWhat are the symptoms of hydronephrosis?
- Babies may be symptom-free, with hydronephrosis often incidentally found on ultrasound.
- Swelling in the baby's belly or flanks might be noticed during bathing.
- Symptoms in babies can include fever or difficulty passing urine if a urinary tract infection is present.
- Older children may experience flank pain.
- Blood in the urine can also be a symptom of hydronephrosis.
What are the causes of hydronephrosis?
Causes of hydronephrosis include:
- Urinary tract obstruction
- Kidney stones
- Congenital abnormalities
- Tumors
- Urinary tract infections
- Inflammation
- Pregnancy-related factors
- Scar tissue from previous surgeries
How is hydronephrosis diagnosed?
Diagnosed prenatally via ultrasound, followed by monitoring with serial scans for blockage and kidney function categorizing as mild, moderate, or severe. Ultrasound and radionuclide scans assess hydronephrosis and renal function.
Pre- and post-birth hydronephrosis management and surgery type?
Observation for mild to moderate hydronephrosis; post-birth ultrasound checks and renal function tests. A renal scan at one month assesses kidney function and outflow. Surgical intervention is considered if functions decline or dilatation worsens.
Sometimes, in specific situations, a study called micturating cystourethrogram (MCUG) is done to check for the retrograde flow of urine from the bladder to the kidney.
Pyeloplasty surgery, performed by laparoscopic or open technique, aims to remove the affected segment and reattach the pelvis with a healthy ureter. Robotic techniques are also an option if available, offering advantages like cosmesis and early discharge from the hospital.
What are the possible complications?
Possible complications of this condition:
- Kidney function deterioration or non-functioning due to repeated infections or severe obstruction.
- The surgeon advised kidney removal in such cases.
- Urine leakage from drain tubes post-surgery, which may resolve spontaneously.
- Placement of a DJ stent across the suturing area by the surgeon for 6-8 weeks.
- Removal of the DJ stent via cystoscopy.
- Wound infection requiring antibiotics.
- Occasional improvement or persistence of red-colored urine post-surgery.
- Possibility of a second procedure if red urine worsens or a lump reappears in the abdomen.
What is the outlook or future of these children?
Surgery success: ~95% of patients with one-sided PUJO have good outcomes. Post-surgery, temporary hydronephrosis isn't concerning initially. Prophylactic antibiotics are needed up to 6 weeks, and follow-up ultrasounds are needed at 3 and 6 months. Severe cases may lead to growth issues.
Conclusion
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