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Hydronephrosis

Hydronephrosis. Hydronephrosis is defined as dilation of the renal collecting system. this may result from obstruction or reflux of urine.

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Hydronephrosis

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  1. Hydronephrosis

  2. Hydronephrosis is defined as dilation of the renal collecting system. this may result from obstruction or reflux of urine. • In children,hydronephrosis is typically discovered during maternal-fetal ultrasound and accounts for approximately 0.5% to 0.6% of all uropathies seen in the neonatal period.

  3. However, one in five neonates with the prenatal diagnosis of hydronephrosis will demonstrate spontaneous resolution of the hydronephrosis. • In the neonates with hydronephrosis, ureteropelvic junction (UPJ) obstruction represents 44% of all postnatal causes of hydronephrosis

  4. High-grade UPJ obstruction results in hydrostatic distention, increased intrapelvic pressure, and poor outflow of urine • Chronic increases in intrapelvic pressure can result in damage to the kidney. • However, with low-grade UPJ obstruction, the developing kidney can remain in a homeostatic state and often shows temporal growth and improvement.

  5. The questions remain, “which patient requires surgical intervention,and which can be observed?”

  6. The incidence of UPJ obstruction is 1 in 1250 births.It occurs more commonly in males . There is 66% for the left side in children. • Both side cases of UPJ obstruction occur in 10% to 36% of patients, with the highest percentage occurring in the younger age group.

  7. UPJ obstruction can affect infants, adolescents, or adults. • The presentation of each differs. Typically, infants are asymptomatic and are now diagnosed by prenatal ultrasonography.

  8. Obstructive causes of hydronephrosis include • UPJ obstruction (44% incidence); • UVJ obstruction (21% incidence); • Multicystic dysplastic kidney, • ureterocele, • duplicated collecting systems (12% incidence); • posterior urethral valves (9% incidence); • ectopic ureter, • urethral atresia, • sacrococcygeal teratoma, • hydrometrocolpos

  9. Nonobstructive causes of hydronephrosis include • VUR (14% incidence), • physiologic dilation, • prune-belly syndrome, • renal cystic diseases, • megacalicosis

  10. Symptoms of UPJ Obstruction in Children • flank pain • abdominal pain • vomiting • infections • Nephrolithiasis • Hematuria • Anorexia • Asymptomatic

  11. The management of possible UPJ obstruction • watchful waiting and early intervention are two main options regarding the management of UPJ obstruction.

  12. surgery • The goal of surgery for UPJ obstruction is to preserve renal function by maintain unobstructed of the renal pelvis.

  13. Anderson-Hynes pyeloplasty

  14. Summary • UPJ obstruction is the most common congenital urinary obstruction. • radiographic studies reveal renal progressive hydronephrosis, and surgery is required.

  15. Unfortunately, the factors that determine which kidneys require surgery have not been clearly defined at this point. • However, with future developments in biochemical markers and improvements in radiographic studies, timing of surgical intervention will be defined earlier.

  16. thanks

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