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PubMed1992

Conservative treatment of neonatal hydronephrosis.

From February 1990 to January 1991, 19 cases of hydronephrosis in children of less than one year of age were managed at Mackay Memorial Hospital. In the majority of these patients, there were evident causes such as ureteropelvic junction stenosis, ureterovesical reflux or a posterior urethral valve for which definite therapeutic measures were performed. However, some cases had no obvious origins and the hydronephrosis was speculated to be from nonobstructive or physiologic dilatation of the kidneys. The conventional tools, such as intravenous pyelogram or renal ultrasound, which comprise the mainstay of diagnosis, provide limited information on renal functional status. Recent introduction of the Tc-99m diethylene triamine penta-acetic acid (DTPA) diuretic renal scan has enabled us to distinguish between obstructive and nonobstructive hydronephrosis and helps us to determine whether or not surgery is necessary. In the past year, eight patients with hydronephrosis of less than one year of age were diagnosed as nonobstructive after a series of evaluations using renal ultrasound, voiding cystourethrography (VCUG) and Tc-99m DTPA diuretic renal scan. Follow-up studies by echography or DTPA renal scan revealed spontaneous resolution of the dilated collecting systems in these cases and confirms our belief that some hydronephrosis in neonates and infants may resolve spontaneously and may just be a manifestation of physiologic change during development. The value of the Tc-99m DTPA diuretic renal scan in the diagnosis of obstructive uropathy is discussed.

Female↗

PubMed1992

[Hydronephrosis and peripelvic cysts. A new echographic sign for the differential diagnosis].

The differential diagnosis of peripelvic cysts and hydronephrosis by means of US sometimes presents some problems; in fact, the use of urography to solve a diagnostic doubt is not uncommon. This study was aimed at demonstrating that another US sign, which we have called the "convexity" sign, can be useful in allowing peripelvic cysts to be distinguished from hydronephrosis. Thus, cysts exhibit convex walls and curved outline, whereas in hydronephrosis the walls of the dilated calices are linear. The latter feature is present in all degrees of hydronephrosis, except in severe cases. Forty-nine adult patients, a total of 98 kidneys, were examined with US and urography; 69 kidneys were found to be pathologic: 48 presented with cysts, and 21 with hydronephrosis. In addition to the new sign, the classic signs of peripelvic cysts were also considered, that is the separate areas and the non-visualization of the ureter. The sensitivity of the new sign was 97% and its specificity was 95%. The sensitivity and the specificity of the classic signs were 97% and 95%, respectively for the separated areas, and 100% and 91% for the non-visualization of the ureter. The cumulative sensitivity of the 3 signs was 99%, and their specificity 96%. Our results show how the integrated analysis of the considered signs (especially those with high specificity) is useful for the differential diagnosis, and therefore to avoid the indiscriminate use of urography.

Adult↗

PubMedDate not supplied

Can renal doppler sonography replace diuretic radionuclide renography in infants with hydronephrosis?

Reliable differentiation between obstructive and non-obstructive hydronephrosis is decisive for the further therapeutic management in infants. The results of renal Doppler sonography were compared with diuretic radionuclide renography and with the follow-up results in 33 patients (range: 21 to 98 days). In Doppler sonography, a resistive index (RI) of > 0.9 was considered to be abnormal in the sense of an obstruction. In diuretic renography, a T1/2 value (time until a 50% decrease in activity in the kidneys was observed after injection of furosemide) of >20 min was appraised as obstructive hydronephrosis. In six patients an obstructive (T1/2 >20 min) and in 27 patients a non-obstructive (T1/2 <20 min) hydronephrosis was found. All patients with obstruction in diuretic renography showed an abnormal RI (>0.9) in Doppler sonography. In addition, all patients with surgery and obstruction in diuretic radionuclide renography showed an improvement in hydronephrosis. However, seven patients had a false-positive result in Doppler sonography. All patients with non-obstruction in diuretic radionuclide renography showed no worsening of hydronephrosis without surgery in the follow-up. We found a RI of 0.84 +/- 0.07 in the non-obstructive group and of 0.96 +/- 0.05 (p = 0.018) in the obstructive group. Doppler sonography showed discrepant results compared to diuretic radionuclide renography and therefore cannot replace this method.

Female↗

PubMed1988

[A staged surgical treatment of an abdominal and iliac aneurysm associated with hydronephrosis and urinoma: report of a case].

Hydronephrosis and urinoma are extremely rare complication of the abdominal aneurysm. A case of the aorto-iliac aneurysm associated with right hydronephrosis and urinoma is reported. The patient is 71 year-old female. She was admitted because of right lower abdominal pain. A diagnosis of the infrarenal abdominal aneurysm with involvement of the common iliac artery and right hydronephrosis due to ureter obstruction was made. A leakage of urine from right renal pelvis (urinoma) was also confirmed. A staged treatment for hydronephrosis was selected. At first, percutaneous nephrostomy was made under ultrasonographic guidance. Urinoma was completely disappeared thereafter. Two weeks later, the aneurysm was replaced with a Y-shaped Dacron graft and the right ureter was mobilized from the perianeurysmal fibrous tissue. On the 35th postoperative day, balloon ureteroplasty was performed through the nephrostomy catheter. Three months after operation, nephrostomy catheter was successfully withdrawn because of improved urinary passage through the right ureter. We emphasize the efficacy of staged surgical treatment combined with percutaneous nephrostomy for the abdominal aneurysm associated with hydronephrosis.

Aged↗

PubMed1983

Ultrasonographic assessment of hydronephrosis of pregnancy.

We examined 100 consecutive patients presenting for gestational assessment by ultrasonography for hydronephrosis. Hydronephrosis in these patients was assessed in respect of its incidence, degree, laterality, and its relation to stage of gestation. Hydronephrosis was found to be present in approximately half of our patients particularly in the second and third trimesters. Hydronephrosis was more prevalent on the right than on the left side. We believe that hydronephrosis of pregnancy is physiologic and that both mechanical and hormonal factors contribute to its occurrence.

Female↗

PubMedDate not supplied

[Hydronephrosis in infancy and childhood].

Hydronephrosis in infancy and childhood is almost always congenital. In 80% of the cases is due to ureteropelvic junction obstruction, in 20% is due to anomalous renal vessels sometimes associated to ureteropelvic junction obstruction. The authors analyze their experience in the surgical treatment of this urinary malformation during a ten years period (1971-1981). 119 hydronephrosis out of 105 patients were operated on. The surgical procedures were successful in 93% of the 119 operated hydronephrosis and in 80% of the giant hydronephrosis. Primary nephrectomy was carried out in only 5% of the operated hydronephrosis (6/119). The Authors stress the importance of early diagnosis to improve surgical results.

Child↗

PubMedDate not supplied

[Hydronephrosis in a horseshoe kidney].

The authors studied hydronephrosis characteristics for horseshoe kidney in 170 patients aged 15-70. Basing on anatomic and functional features and urethral condition in each patient 136 operative interventions on one or two parts of the fused kidney in 125 patients were conducted. 26 heminephrectomies were carried out in hydronephrosis stage III, pyonephrosis and acute purulent focal pyelonephritis. 110 stage I-II hydronephrosis patients underwent an original reconstructive combined surgery on the fused kidney ending in formation of two separate organs. High incidence of hydronephrosis in horseshoe kidney against that in normal kidney (64 and 7%, respectively) and not infrequent bilateral involvement (63%) can be explained by anomalous structure of the organ conducive to obstruction of the urinary tracts. In 136 surgical cases the obstruction was due to: peripelvic compression of the ureter above the isthmus of the kidney (128 cases), high branching of the ureter from the renal pelvis with formation of the "spur" (114 cases), periurethritis and the fixed peripelvic ureteral kink by the adhesions (64 cases), congenital stricture of the peripelvic ureter (42 cases) or its compression by the accessory vessel (12 cases). To correct these abnormalities, it is reasonable to employ reconstructive surgery proposed by E. M. Shimkus. The procedure implies the isthmus resection with renal segment part, resection of the lower calyx, pelvic plasty according to Anderson-Hines technique, pyelolithotomy and nephropexy. This surgery abolishes all the underlying causes of fused kidney hydronephrosis and reestablishes urodynamics. It secured positive results by 2-28-year follow-up in 95% of the patients and is recommended as a method of choice.

Adolescent↗

PubMed1996

Fetal hydronephrosis, a one year follow up.

OBJECTIVE: To determine the underlying urological anomalies and the outcome during the first year, in babies with antenatally diagnosed hydronephrosis. DESIGN: A prospective descriptive study. SETTING: Southlands and Worthing Hospitals, Worthing, UK. METHOD: From January 1991 to December 1992, in the Worthing District Health Region, UK all babies with hydronephrosis persisting postnatally (69) were prospectively assessed for renal growth and function, general well-being, and complications if any. The diagnoses, treatment and complications occurring during the first year were analysed. RESULTS: Of the 69 babies 4 were lost to follow up. The 65 fetuses assessed had the following underlying causes: transient in utero hydronephrosis 34 (52.3%), idiopathic hydronephrosis 9 (13.8%), isolated vesico-ureteric reflux 5 (7.6%), vesico-ureteric reflux with other urological abnormalities 2 (3.1%), pelvi-ureteric junction obstruction 2 (3.1%), equivocal pelvi-ureteric junction obstruction/idiopathic hydronephrosis 4 (6.2%), multicystic dysplastic kidney 4 (6.2%), polycystic kidneys 1 (1.5%) and patulous extrarenal pelvis 4 (6.2%). During one year of follow up 4 (6%) of babies needed surgical intervention and further 6 (9%) needed antibiotic prophylaxis. CONCLUSION: The majority of fetal hydronephroses is were self-limiting or benign. Vesico-ureteric reflux was the commonest urological abnormality. 23 (33%) apparently normal neonates detected on prenatal screening needed aggressive management or close monitoring.

Female↗

PubMed1997

Prenatal intervention for hydronephrosis.

PURPOSE: The widespread use of prenatal ultrasound results in an increased recognition of fetal hydronephrosis and technological advances now make fetal intervention possible. However, efficacy is unknown, and there have been errors in diagnosis, and associated morbidity and mortality. This review focuses on the current status of prenatal diagnosis and management of hydronephrosis. MATERIALS AND METHODS: The relevant literature on prenatal physiology, prenatal diagnosis, experimental obstruction and clinical series of prenatal intervention was reviewed. RESULTS: Prenatal ultrasound is a poor discriminator of physiological hydronephrosis, obstruction, renal dysplasia and reflux. Persistent early onset oligohydramnios is the best predictor of poor neonatal outcome. New minimally invasive techniques may aid diagnostically but they may not improve outcome. Dysplasia is often present by the time hydronephrosis is detected and it is not reversible in experimental models. Prenatal intervention is technically feasible but the survival rate is only 47%, and catheter placement and open fetal surgery have significant fetal and maternal risks. Complications occur in up to 45% of fetuses. CONCLUSIONS: Prenatal intervention for hydronephrosis remains an experimental technique. The most important question is whether prenatal therapy for obstructive uropathy improves survival and decreases long-term morbidity and mortality in affected fetuses.

Animals↗

PubMedDate not supplied

[Long-term results of plastic surgery in hydronephrosis in children].

94 children (109 kidneys) with congenital hydronephrosis were treated in 1989-1997. 67 of them underwent 76 plastic operations: Andersen-Hynes operation on the ureteropelvic segment without pelvic resection (n = 53), antevasal pyelopyelo- and ureteropyeloanastomosis (n = 18), ureteropyelolysis (n = 5). Excellent, good and satisfactory results were obtained in 16.5, 50.6 and 30.4% of cases, respectively. The analysis of changes in the renal-cortical index before and after plastic operation with reference to hydronephrosis stage and form, type of the pelvis evidenced that the best treatment outcomes were achieved in children with open hydronephrosis stage II having extrarenal pelvis. Poor outcomes occurred in closed hydronephrosis stage III and intrarenal pelvis. Renal planimetry, as one of highly informative diagnostic techniques, can be used in assessing results obtained in hydronephrosis treatment.

Adolescent↗

PubMedDate not supplied

[Fetal hydronephrosis: postnatal management and follow up].

OBJECTIVE: Fetal hydronephrosis is being detected with increasing frequency and probably this observation will increase as the quality of ultrasound equipment improves. This study evaluated etiology and postnatal clinical outcomes of prenatally detected hydronephrosis. METHODS: In a period of 13 years 148 infants were referred with fetal hydronephrosis. The initial evaluation, after prophylaxis, included ultrasound and voiding cystography. Sequential evaluation was determined by initial findings. RESULTS: Postnatal predominant diagnosis were pelviureteric junction obstruction (24%) and hydronephrosis without obstruction (18%). Follow up median was 38.7 months. Renal function deteriorated in 13 (8.8%) children and 11 (7.4%) died during follow up. Bad prognosis was associated with urethral obstruction. CONCLUSIONS: Fetal hydronephrosis is a clue of urinary tract anomalies. Urinary tract infections and delay in postnatal diagnosis must be prevented in children with this uropathy.

English Abstract↗

PubMed1999

Congenital hydronephrosis who requires intervention?

PURPOSE: To analyze the predictive value of early postnatal ultrasonography in congenital hydronephrosis. SUBJECTS AND METHODS: A retrospective study was conducted of 77 affected infants at our institution. All postnatal ultrasound studies were evaluated using 2 classification systems, the Anterior-Posterior Diameter (APD) system and the Society for Fetal Urology (SFU) system. Each study was compared to subsequent ultrasound examinations, renal scans, and to clinical outcome. RESULTS: There were 115 dilated renal units. Fifteen (13%) underwent intervention; all initially had high grade hydronephrosis on both classification systems. One hundred renal units (87%) were managed conservatively; 47 had low grade hydronephrosis and only 18 had high grade hydronephrosis on both systems. CONCLUSIONS: Using both the APD and the SFU classification systems together on the initial postnatal ultrasound is superior to using either method on its own, and the combined system enables us to predict the outcome of infants with congenital hydronephrosis.

Journal Article↗

PubMed1997

Hydronephrosis after simple hysterectomy for benign disease: a prospective study.

OBJECTIVES: To determine the prevalence and implications of transient asymptomatic hydronephrosis following simple hysterectomy for benign disease. METHODS: Over a 12-month period, 50 consecutive women undergoing total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were evaluated. Renal ultrasound to detect asymptomatic hydronephrosis, renal function tests and urinalysis were performed preoperatively and at 3 days and 6 weeks after surgery. RESULTS: Hydronephrosis was not identified in the early or late postoperative period in any of the 50 evaluated patients. Concomitant bilateral salpingo-oophorectomy did not have any impact on this result. CONCLUSIONS: We did not find any cases of transient asymptomatic hydronephrosis occurring after simple, uncomplicated hysterectomy for benign disease. This suggests that silent ureteral dysfunction does not occur as a result of the surgical technique itself. As such, any postoperative finding of asymptomatic hydronephrosis warrants further investigation.

Journal Article↗

PubMed1977

Arterial hypertension in infants with hydronephrosis. Report of six cases.

Six infants with hydronephrosis developed hypertension during the first year of life. Five of them, all with proved or suspected acute urinary tract infection, had transient hypertensive episodes lasting for 7 to 17 days. One of the five infants, who had ureteropelvic junction obstruction and unilateral hydronephrosis, remained normotensive after nephrectomy. The sixth patient, with bilateral hydronephrosis and elevated peripheral vein renin activity, has had persistent hypertension. We discuss possible mechanisms underlying hypertension in these infants and suggest that young patients with hydronephrosis may be unusually predisposed to acute hypertensive episodes.

Blood Pressure↗

PubMed1988

The impact of hydronephrosis on renal function in patients treated with cisplatin-based chemotherapy for metastatic nonseminomatous germ cell tumors.

We analysed renal function before and after chemotherapy in 130 patients with large (greater than 5 cm in diameter) abdominal masses from malignant non-seminomatous germ cell tumors (NSGCT). The mean glomerular filtration rate assessed by 51Chromium (51Cr) ethylenediamine tetraacetic acid (EDTA) clearance was lower in 46 patients with radiologic evidence of hydronephrosis than in 84 patients with abdominal masses but no hydronephrosis (102 ml/min versus 139 ml/min; P less than 0.01). Patients with hydronephrosis who were treated with cisplatin-based chemotherapy demonstrated a slight early improvement in renal function followed by a fall, in contrast to those treated with carboplatin-based chemotherapy in whom renal function improved. Patients with hydronephrosis who showed no improvement in glomerular filtration rate after the first course of chemotherapy were at an increased risk of renal atrophy and chronic renal damage developing. Long-term renal toxicity may be avoided in these patients either by the use of carboplatin or by the use of drainage procedures such as ureteric stenting or nephrostomy.

Adolescent↗

PubMed1994

Clinical outcome and follow-up of prenatal hydronephrosis.

Between 1987 and 1991, 160 hydronephrotic kidneys were diagnosed prenatally and confirmed postnatally in 100 infants. The aim of the study was to describe the natural history and management of primary hydronephrosis detected prenatally. We devised a new classification of obstructive uropathy outcome using ultrasonography and the diethylenetriamine penta-acetic acid scan. Accordingly, we classified the patients as having mild, moderate or severe hydronephrosis. Nine patients had pyeloplasties and 5 had ureteric reimplantations. We conclude that in most cases there is no need for immediate surgery, and that the initial approach to the management of congenital hydronephrosis should be conservative. We suggest that anti-bacterial prophylaxis be conventionally given to infants with vesicoureteral reflux and for the first 6 months of life to infants demonstrating moderate to severe newborn primary hydronephrosis.

Female↗

PubMed1981

Kidney function and histopathological changes in unilateral hydronephrosis with special reference to bilharzial ureter.

Fifty-six patients with unilateral hydronephrosis were the subject of this study. The patients were classified into 4 groups according to the stage of hydronephrosis as assessed by radiological criteria. Split kidney function, histopathological studies, and measurement of intraureteral pressure were performed. Urinary Bilharziasis was held responsible for obstructive nephropathy in 77% of cases. Complicating urinary infection was present in 66%. The study has shown that creatinine excretion was slightly decreased in early, moderate, and moderately advanced hydronephrosis. On the other hand, a marked lowering of urine osmolality was found even in the early stages of hydronephrosis. The hydronephrotic kidney was found to be a salt losing one only in early, moderate, and moderately advanced hydronephroses, but not in the very advanced cases. The histopathological changes were mainly tubular, but some cases showed proliferative changes in the glomeruli. Eradication of urinary Bilharziasis and early treatment of this disease would markedly contribute to the prevention of obstructive nephropathies in countries where this disease is endemic.

Adult↗

PubMed2004

Renal artery embolization: a first line treatment option for end-stage hydronephrosis.

UNLABELLED: Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. PATIENTS AND METHODS: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles. RESULTS: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. CONCLUSION: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.

Adult↗