scholarly journals Postnatal management of children with antenatal hydronephrosis

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Mohammed S. ElSheemy
Keyword(s):  
Renal Function ◽  
Urinary Tract Obstruction ◽  
Cost Effective ◽  
Voiding Cystourethrography ◽  
Main Body ◽  
Antenatal Hydronephrosis ◽  
Postnatal Management ◽  
Effective Manner ◽  
Lower Urinary Tract Obstruction

Abstract Background Postnatal management of infants with antenatal hydronephrosis (ANH) is still one of the most controversial issues. The majority of infants with ANH are asymptomatic with only few children who develop renal insufficiency. Thus, the biggest challenge for pediatric urologists is to distinguish children who will require further investigations and possible intervention prior to the development of symptoms, complications or renal damage in a cost effective manner without exposing them to the hazards of unnecessary investigations. Main body In this review article, literature on ANH were reviewed to present the current suggestions, recommendations, guidelines and their rational for postnatal management of ANH. It is agreed that a large portion of infants with ANH will improve; thus, the protocol of management is based mainly on observation and follow-up by ultrasound to detect either resolution, stabilization or worsening of hydronephrosis. The first 2 years of life are critical for this follow-up as the final picture is mostly reached during that period. Advanced imaging using voiding cystourethrography or renal scintigraphy are required for children at risk. Then, surgical intervention is selected only for a subgroup of these infants who showed worsening of hydronephrosis or renal function. Conclusions The protocol of management is based mainly on observation and follow-up by US to detect either resolution, stabilization or worsening of hydronephrosis. Postnatal evaluation should be performed for any neonate with a history ANH at any stage during pregnancy even if it was resolved during third trimester. Exclusion of UTI should be performed by urinalysis for all cases followed by urine culture if indicated. Serum creatinine should be performed especially in patients with bilateral ANH. US is the initial standard diagnostic imaging technique. Other imaging modalities like VCUG and nuclear renal scans may be required according to the results of the US evaluation. The most important items in decision making are the presence of bilateral or unilateral hydronephrosis, presence or absence of hydroureter, presence of lower urinary tract obstruction and degree of hydronephrosis on the initial postnatal US. Then an intervention is selected only for a subgroup of these patients who showed deterioration in renal function or degree of hydronephrosis or were complicated by UTIs. All these recommendations are based on the available literature. However, management of ANH is still a controversial issue due to lack of high evidence-based recommendations. Randomised controlled studies are still needed to provide a high level evidence for different aspects of management.

scholarly journals Antenatal and postnatal management of posterior urethral valves: where do we stand?

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Ahmed Abdelhalim ◽  
Ashraf T. Hafez
Keyword(s):  
Renal Function ◽  
Renal Transplantation ◽  
Urinary Tract Obstruction ◽  
Relevant Literature ◽  
Posterior Urethral Valves ◽  
Current Status ◽  
Main Body ◽  
Surgical Interventions ◽  
Urethral Valves ◽  
Lower Urinary Tract Obstruction

Abstract Introduction Posterior urethral valve (PUV) is the leading etiology of lower urinary tract obstruction (LUTO) in boys and is an important cause of end-stage renal disease (ESRD) in children. The aim of this article is to review the current status on antenatal intervention for PUV as well as postnatal medical and surgical management. Main body MEDLINE, EMBASE, Pubmed and Google Scholar search was conducted throughout December 2020 using the keywords: posterior urethral valves, congenital urinary obstruction, antenatal, valve bladder syndrome, medical, anticholinergics, alpha blocker, antibiotics, biofeedback, diversion, augmentation cystoplasty and renal transplantation. Only papers written in English were included. The relevant literature was summarized. Despite advances in antenatal intervention for fetal LUTO, it remains associated with considerable fetal and maternal morbidity. Patient selection criteria for antenatal intervention are greatly debated. Fetal intervention has resulted in improved perinatal survival in properly selected cases, with a questionable benefit to postnatal renal function. There is decent evidence supporting the use of anticholinergics in infants and young children following valve ablation, with less robust evidence advocating alpha blockers, overnight catheter drainage and biofeedback. The role of urinary diversion remains contentious. Optimizing bladder dynamics is crucial for successful renal transplantation outcomes. Conclusion While antenatal intervention has failed to improve renal function outcomes of PUV, patient-centered medical and sometimes surgical interventions can help delay the progression of chronic kidney disease. Lifelong monitoring and management of the associated bladder dysfunction is indispensable even after successful renal transplantation.

scholarly journals Postnatal evaluation of intrauterine hydronephrosis due to ureteropelvic junction obstruction

2013 ◽  
Vol 28 (suppl 1) ◽  
pp. 33-36 ◽  
Author(s):  
Carlos Augusto Fernandes Molina ◽  
Inalda Facincani ◽  
Valdair Francisco Muglia ◽  
Whemberton Martins de Araujo ◽  
Marcelo Ferreira Cassini ◽  
...  
Keyword(s):  
Renal Function ◽  
Surgical Treatment ◽  
Surgical Approach ◽  
Urinary Tract Obstruction ◽  
Ureteropelvic Junction ◽  
Fetal Hydronephrosis ◽  
Antenatal Hydronephrosis ◽  
Upj Obstruction ◽  
Definition Of

PURPOSE: Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. METHODS: 116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. RESULTS: In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. CONCLUSION: Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.

scholarly journals Fetoscopic laser valve ablation in the posterior urethral valve case with intrauterine diagnosis

2020 ◽  
Vol 28 (3) ◽  
pp. 206-211
Author(s):  
Selahattin Kumru ◽  
Serdar Kaya
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Treatment Options ◽  
Posterior Urethral Valve ◽  
Fetal Ultrasonography ◽  
Lower Urinary Tract Obstruction ◽  
Urethral Valve ◽  
Lower Urinary

Objective: We aimed to present the procedure of intrauterine percutaneous fetoscopic laser valve ablation performed on a fetus diagnosed with lower urinary tract obstruction. Case(s): Bilateral hydroureteronephrosis, dilated bladder and oligo/ anhydramnios were found in the fetal ultrasonography examination of a 21-year-old pregnant woman who did not have regular follow-ups, and the lower urinary tract obstruction consistent with the posterior urethral valve was considered in the case. The patient who was found to have poor prognosis as a result of vesico synthesis carried out consecutively was informed about the follow-up and treatment options, and the posterior urethral valve ablation was performed by the percutaneous fetoscopic laser on 27 weeks of gestation. The amniotic fluid was at normal levels after the procedure, and the labor was carried out at term. The newborn with elevated postpartum creatinine was diagnosed with stage 2 renal failure, but dialysis was not required during the follow-ups. The newborn was discharged for outpatient follow-up upon the reduced creatinine levels. Conclusion: By taking the survival enhancing effect of the intrauterine intervention into account in the presence of lower urinary tract obstruction, we considered that intrauterine intervention can be an option in the cases who prefer to continue their pregnancies. The families should be informed in detail about the benefits and risks of intrauterine intervention to repair the obstruction.

Evaluating a Workshop Model for Improving Diabetes Patient Education Programs: Is It Really Successful?

1986 ◽  
Vol 12 (1) ◽  
pp. 48-50 ◽  
Author(s):  
Sandy Cook ◽  
Rita M. Cohen
Keyword(s):  
Patient Education ◽  
Health Professionals ◽  
Cost Effective ◽  
Diabetes Patient ◽  
Education Programs ◽  
Commitment To Change ◽  
Effective Manner ◽  
Workshop Model

Over a threx-year period, 54 health professionals at tended three two-day workshops designed to improve diabetes patient education programs, par ticularly program manage ment and evaluation of skills. A commitment-to- change strategy was used to determine the long-term effectiveness of the workshops. Fifty-nine per cent overall of the com mitments to change were reported as attained in the six-month follow-up surveys. The evidence suggests not only that the workshops were suc cessful, but that measurable changes in participants' programs can be attained in a cost- effective manner.

758: Fetal serum beta 2-microblogulin and postnatal renal function in lower urinary tract obstruction

2016 ◽  
Vol 214 (1) ◽  
pp. S397-S398
Author(s):  
Ramen H. Chmait ◽  
Andrew H. Chon ◽  
Gustavo H. de Oliveira ◽  
Kevin V. Lemley ◽  
Lisa M. Korst ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Lower Urinary Tract Obstruction ◽  
Fetal Serum ◽  
Beta 2 ◽  
Lower Urinary

A Sustainable Model for Patient follow-up following an International Cleft Mission

2018 ◽  
Vol 55 (7) ◽  
pp. 977-982 ◽  
Author(s):  
Ari M. Wes ◽  
Nadine Paul ◽  
Patrick A. Gerety ◽  
Nancy Folsom ◽  
Jordan Swanson ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cellular Phone ◽  
Cost Effective ◽  
Mobile Telephones ◽  
Surgical Mission ◽  
Care And Support ◽  
Effective Manner ◽  
Rural Settings ◽  
The Cost

Purpose: Patient follow-up after cleft missions is imperative if we are to critically assess the quality of care provided in these settings. The adoption of mobile telephones among disadvantaged families abroad may enable such an undertaking in a cost-effective manner. This project aimed to assess the efficacy of cellular phone-based follow-up in a developing country following a cleft mission to Thailand. Methods: Changing Children's Lives Inc. performed a cleft surgical mission to Udon Thani, Thailand, in January 2013. Telephone numbers collected at that time were used to survey the patients or their parents 1.5 years postoperatively. Results: Of the 56 patients who underwent cleft lip and/or palate surgery during the mission, more than 50% ( n = 30, 54%) were reachable by telephone; all chose to participate in the study. The cost for families was U.S. $124.92 (56.15); 26 families (87%) believed their money was well spent. Follow-up care was received by 22 (73%) patients, and all but one family ( n = 29, 97%) felt that their child received all of the medical care and support required. All families ( N = 30) would recommend similar cleft care to a friend. Of the patients younger than 18 years of age ( n = 24, 80%), 20 (80%) families found their child more comfortable interacting with peers, more comfortable interacting with adults, and more confident postoperatively. Conclusion: In one month, a survey response rate of more than 50% was obtained by leveraging the increased adoption of mobile phones in rural settings. Nearly all patients/families treated during the cleft mission were satisfied with the care that they received.

scholarly journals Long-term drug treatment of a giant liver hydatid cyst in a child

2020 ◽  
Author(s):  
Valeri Velev ◽  
George Donkov ◽  
Yordanka Mitova-Mineva
Keyword(s):  
Conservative Treatment ◽  
Diagnostic Imaging ◽  
Treatment Options ◽  
Cost Effective ◽  
Intermediate Hosts ◽  
Appropriate Treatment ◽  
Effective Manner ◽  
Ionizing Radiations

Abstract BackgroundCystic еchinococcosis is a chronic parasitosis caused by the larvae of the tapeworm Echinococcus granulosus. Humans act as intermediate hosts and the larvae can affect any organ in the form of cysts. They are most often found incidentally by diagnostic imaging, where they have become large in size, with treatment being primarily invasive. Conservative treatment with albendazole is one of the appropriate treatment options, but it features a low success rate in cysts over 5 cm.Case presentationWe describe a case of an 14-year-old girl with an active 12 cm cyst in the liver. Two consecutive courses with albendazole, with duration 3 months each, were conducted. The cyst reached a safe inactive stage and no relapses have been observed for 1 year since the last administration of the medication.ConclusionsOur experience shows that with large cysts albendazole courses may be extended including in childhood. Ultrasonography has clearly demonstrated its ability to follow-up patient in a cost effective manner and avoiding ionizing radiations.

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