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Hydronephrosis In Child Treatment Delhi

Many people have never heard of the term hydronephrosis. Thatu2019s because it is only prevalent in around 1% of the general population according to a research paper published by Science Direct. Hydronephrosis can affect both children and adults. In fact, it can even affect babies in the womb; this can be found via prenatal ultrasound. The same study by Science Direct observed that 1 in 100 to 200 fetuses suffered from hydronephrosis. Because of this, finding out that you suffer from hydronephrosis and require surgery might seem daunting. But donu2019t worry about it. You can find hydronephrosis treatment in Delhi without breaking a sweat!

DrPrashantJain
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Hydronephrosis In Child Treatment Delhi

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  1. Antenatal Antenatal Hydronephrosis Hydronephrosis(ANH): Surgical Aspects Surgical Aspects (ANH): Dr Dr Prashant Prashant Jain Sr. Consultant Sr. Consultant Pediatric Surgery & Pediatric Urology Pediatric Surgery & Pediatric Urology Dr BLK BLK Superspeciality Superspeciality Hospital, New Delhi Jain Dr Hospital, New Delhi

  2. Antenatal Hydronephrosis  Renal anomalies accounts for 17% of all the congenital anomalies  Hydronephrosis is commonest (1-5% of all pregnancies)  Management dilemma

  3. ANTENATAL HYDRONEPHROSIS DILATATION OF FETAL RENAL COLLECTING SYSTEM Transient dilatation (41 to 88%) Vesico-ureteric reflux (10 -20%) True Obstruction (20 -50%)

  4. What is True Obstruction??? • Anatomical or Functional impairment in urinary drainage from kidney which ultimately is going to affect the renal function Impairment in Urinary drainage Dilatation Impairment of renal functions

  5. True obstruction Pelvi Ureteric Junction Uretero-vesical Junction Bladder outlet Posterior Urethral Valve

  6. Why diagnostic Dilemma?  Transient impairment of urinary flow  Permanent impairment of urinary flow IMPORTANT TO DIFFERENTIATE

  7. Evaluation Of ANH Ultrasound Micturiting Cystourethrogram Nuclear renal scan * DRCG * DMSA * DTPA Magnetic Resonance Urography (MRU) - - - -

  8. Antero-Posterior Diameter of Renal Pelvis (Transverse plane)

  9. Definition of ANH by AP(Antero-Posterior) Diameter of Renal Pelvis Mild 4 to <7 mm 7 to <9 mm Moderate 7 to 10 mm 9 to 15 mm Severe >10 mm >15 mm Second trimester Third trimester

  10. Case: Antenatal hydronephrosis  Antenatal scan- 32 wks  Lt hydronephrosis with dilated pelvicalyceal system; No hydroureter  Antero-posterior(AP) diameter of Lt renal pelvis: 13 mm  AFI: 9  What Next?? 13mm

  11. Counseling is Challenge…..  Is it a transient dilatation or pathological dilatation?  What is accurate diagnostic tool?  How to prognosticate?  How long to follow?  When to operate?

  12. Risk Of Postnatal Pathology  Mild: 11.8%  Moderate:44.1%  Severe: 88.3%

  13.  Moderate hydronephrosis (Resolution: 40- 50%)  CAN NOT BE IGNORED  Re-assessment after delivery  Will require regular follow up with USG and renal scans  Continue pregnancy till term

  14. Post natal  Newborn passing urine  Bladder not palpable What Next?  USG KUB after 48-72hrs AP Diam: 14mm What Next?  Chemoprophylaxis  USG & DTPA Scan after 1 month of age

  15. ANTENATAL HYDRONEPHROSIS Post Natal USG at 48 -72 hrs Hydro-ureteronephrosis present No hydronephrosis Hydronephrosis present Mild Chemoprophylaxis Early MCU Moderate/severe Repeat USG at 3 months USG at 3, 6, 12 mths Chemoprophylaxis ??MCU DTPA Scan No hydronephrosis No further evaluation B/L HN, BLADDER OUTLET OBSTRUCTION, AND SINGLE KIDNEY NEEDS EARLY EVALUATION

  16. Consider Surgery  Split function is < 40%  Progressive increase in AP diameter  Symptomatic

  17. RK AP DIAMETER LK AP DIAMETER ANTENATAL - 14 MM DAY3 - 14 MM 1MTH - 18 MM DTPA scan 3MTH - 18 MM 6MTH 19 12MTH 19 Advised DTPA scan

  18. At 2 months of age

  19. At 1 year of age

  20. Pyeloplasty

  21. Case: Antenatal Hydronephrosis Rt AP of Pelvis diameter of 6 mm 20 wks scan Rt AP diameter of pelvis 8 mm 28 wks scan Rt AP diameter of pelvis 7mm 36 wks scan Before discharge Rt AP of Pelvis diameter of 8 mm Rt AP of Pelvis diameter of 8 mm USG at 1mth USG at 3mth & 1 year No dilatation

  22. Antenatal Scan 32 wks  Bilateral hydronephrosis and hydroureter  Bilateral AP diameter 7mm  Bilateral echogenic kidneys  Bladder full; Key hole sign  AFI 8

  23. • POSSIBILITIES????

  24. Antenatal Scan: Hydrouretronephrosis  Vesico-ureteric reflux  Vesico-ureteric junction obstruction  Posterior Urethral Valve

  25. Counseling  Obstruction at vesico-urethral junction  Need for surgery(Endoscopic Fulgaration)  Need for long term follow up  Risk of ESRD

  26. Case… 37 wks, LSCS, 1.6 kg USG: B/L HN & HU Thinned out renal parenchyma Thickened and distended bladder Catheterised Serum Na: 132 Serum K: 5.3 S. Creatinine:1.6 VBG: Normal Urine C/S: sterile

  27. MCU

  28. Endoscopic Fulgaration of Valves

  29. Post Operataive  Stable  Polyuria: 5ml/kg/hr(Post operative diuresis)  Catheter removed after 72 hrs  Polyuria Settled in 7 days  Discharged with S.Creatinine of 1meq/l  Chemoprophylaxis  Anticholinergics (Tropan)

  30. Follow up  Intermittent dribbling present  Urinary Stream good  DMSA: left scarred kidney  S.Creatinine : 0.6  Dilatation on USG is less, PVR5 ml  Now 2yrs  No chemoprophylaxis  Needs long term follow up  MCU on follow up

  31. Fulgaration with resectocope

  32. Case  Ante natal USG s/o left moderate hydronephrosis  Repeat USG, dilatation of upper kidney with hydroureter s/o duplex system and ureterocele

  33. VCUG and MRU

  34. Ureterocoel Incision

  35. Repeat USG after 2 wks

  36. CASE  Antenatal scan 32 wks  Left hydronephrosis AP diam of renal pelvis 11mm  Left ureteric dilatation present  Right Kidney normal  Bladder normal

  37. Post natal  Term male newborn;3kg  Newborn passing urine  Bladder not palpable WHAT NEXT  Antibiotic prophylaxis  USG KUB after 48-72hrs AP Diam: 11mm;Ureter dilated WHAT NEXT  MCU under antibiotic cover

  38. MCU • Rt Grade III VUR

  39. DMSA Scan • Scarred left kidney

  40. Follow up Advice  Chemoprophylaxis  Early toilet training  Avoid constipation  Perineal Hygine  Growth/BP monitoring  Regular Urine examination/ultrasounds/DMSA scan

  41. When to intervene?  Recurrent breakthrough UTI  Progressive scars in DMSA SCAN  Parents choice  Endoscopic injection Vs Ureteric Reimplantation

  42. STING technique (Subureteric transurethral injection) 43

  43. Follow Up  Chemoprophylaxis stopped  Follow up with nephrologist

  44. CARRY HOME MESSAGE Do not ignore ANH even if it is transient Remember AP diameter of pelvis 4/7/10 mm Most ANH just need surveillance Hydronephrosis is not synonymous with obstruction Be positive, supportive, ANH usually have good prognosis.     

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