Antenatal (Fetal) Hydronephrosis: Management after birth- Dr A.K.Singal/ Dr Ashwitha Shenoy скачать в хорошем качестве

Antenatal (Fetal) Hydronephrosis: Management after birth- Dr A.K.Singal/ Dr Ashwitha Shenoy

Uploaded by Department of Pediatric Urology, Mitr Hospital, India +91-2227743558/ 4229/ 4239 and +91-9324180553 1. Is there any treatment required in the antenatal period? a. For unilateral antenatal hydronephrosis no treatment is required. For both sided hydronephrosis with suspected PUV and decrease in liquor, between 24-32 weeks- there may be a role for fetal therapy b. After 32 weeks early delivery if liquor decreases. Relevant steroid therapy to mature the lungs and immediate care by pediatric urologist after the birth of the child. Immediate care involves neonatal ICU admission, monitoring urine output, an ultrasound. 2. When should the ultrasound be done in newborn? a. If the Hydronephrosis is Unilateral, ultrasound is done after first 7 days as initial oral intake of the baby is poor and the degree of hydronephrosis seen on the ultrasound may not be accurate. b. For both sided hydronephrosis with suspected PUV, child should be admitted in NICU and tests performed to rule out PUV which involves an urgent ultrasound followed by MCU. 4. What other tests will be required and when? a. For unilateral hydronephrosis – USG between 7-10 days and then at 6-8 weeks depending on the degree of hydronephrosis and then further tests depending on the diagnosis and severity of hydronephrosis. b. If severe or worsening hydro, your doctor may ask for a Diuretic renal scan around 6-12 weeks of age. Diuretic scan is generally not done before 6 weeks of age as kidneys may be immature. Diuretic renal scan may be recommended earlier if there is bilateral or severe hydronephrosis requiring surgery. c. For suspected cases of PUV- a MCU is needed in first few days of life and then further surgery. d. For children with suspected vesico-ureteric reflux an MCU may be done around 3-4 months of age. 5. Is surgery required in all the children after birth? a. Surgery is not needed in all cases of ANH and it depends on the diagnosis, severity of hydronephrosis, kidney function and symptoms. For PUJ obstruction, if the swelling is severe and kidney function drops- surgery may be needed early in first 2-3 months of life. In some children with PUJ obstruction, we may have wait even for 2-3 year and see the progression of hydronephrosis and recommend surgery only if they have worsening swelling on ultrasound or loss of function on diuretic scan. b. For children with vesico-ureteric reflux – if there are no infections, we just wait for the reflux to resolve which happens in 80-90% of children. For others also if there is residual reflux but no infections, we do not recommend surgery. But if there are culture positive urine infections inspite of all care & preventive antibiotics, we recommend anti-reflux surgery. c. For children with posterior urethral valves, surgery is always needed, and we perform it in the first week of life itself. Now we have availability of newborn telescopes to do surgery in children who are even preterm or 1.5kg at time of birth. 6. Is laparoscopic surgery possible for hydronephrosis? a. For children with severe PUJ obstruction laparoscopic surgery called laparoscopic pyeloplasty is very much possible. For the last 15 years, we have been doing exclusive pediatric laparoscopic pyeloplasties for all children with PUJ obstruction who need surgery and are more than 3-4 months of age. The youngest child has been 3 months of age. Cdc b. The results of laparoscopic pyeloplasty are same as open surgery but the pain is much less, the recovery is quite fast, shorter hospitalization and less scars on tummy. 7. Can children with antenatal hydronephrosis live normally? a. To sum it up most of the children with antenatal hydronephrosis live normally. 70-80% may not need any treatment but definitely all of these need follow-ups to find those who do need treatment or have falling kidney function.