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in Children
Bustanul Arifin Nawas
Divisi Bedah Anak FK UNPAD
Hydronephrosis
Dilatation of renal collecting system result from
obstruction or reflux of urine
Interaction between glomerular hemodynamic and
alteration in tubular function
Discovered during maternal-fetal ultrasound
20-25% spontaneous resolution
Neonates with persistent hydronephrosis (44%),
caused by UPJ Obstruction
UPJ Obstruction
High Grade UPJ Obstruction
Result in hydrostatic distention, increased intrapelvic
pressure, & poor outflow urine
Chronic process irreversible kidney damage
Low Grade UPJ Obstruction
Etiology
Absence or reduction
of circular muscle fiber
Abnormality of
peptidergic innervation
Down regulation of
Cajal cell
Pathophysiology
Failure of transmission of
the peristaltic waves
across the UPJ
Failure of propulsion of the
urine ineffective
peristaltic wave
hydronephrosis
Etiology
Aberrant/crossing
renal vessel
Adhesive band
Arteriovenous
malformation
Ureteral fold
Pathophysiology
Compression, angulation,
or kinking of the UPJ
Clinical Presentation
Infant
Asymptomatic
Hydronephrosis discovered by prenatal US
Children
Diagnostic Evaluation
1. Renal Ultrasonography
. to demonstrate dilatation
. information of the severity of hydronephrosis and
thickness of the renal cortex
. to indicate the level of obstruction
Grading of hydronephrosis (SFU)
Diagnostic Evaluation.
Diagnostic Evaluation.
2. Renal Scintigraphy :
to asses severely impaired renal function
to distinguish between obstructive and non-obstructive
dilatation
quantify differential renal function
Diagnostic Evaluation.
3. Voiding Cystourethrography
Diagnostic Evaluation.
Management
Conservative management (watchful waiting) :
Direct physical examination
Ultrasound after birth (min 2 days)
Additional studies if UPJ obstruction is highly suspected.
Operative management :
Open surgery
(Flap techniques, Dismembered pyeloplasty)
Minimal invasive surgery
(Laparoscopic pyeloplasty, Robotic surgery, Endopyelotomy)
Management
Unilateral antenatal
hydropnephrosis
Postnatal
US
(2-5 days)
SFU grades
III and IV
SFU grades
I and II
US
4-8 weeks
Hydronephrosis
stable/resolved
Hydronephrosis
worsen
Repeat US vs
Observation
VUR
VCUG
3-6 months
Diuretic renal scintigraphy
vs
Gd-MRU
Manage VUR
Surgical criteria
met
Surgical criteria
not met
Surgery
Reassess 3-6
months
Management
Dismembered Pyeloplasty
(Anderson-Hynes)
Prognosis
Thank You