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 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.

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

2020 ◽  
Vol 20 (2) ◽  
pp. 61-64
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
Rifat Zaman ◽  
Md Amanur Rasul ◽  
Akm Shahadat Hossain ◽  
Shafiqul Alam Chowdhury ◽  
...  
Keyword(s):  
Renal Function ◽  
Low Dose ◽  
Ureteropelvic Junction Obstruction ◽  
Percutaneous Nephrostomy ◽  
Ureteropelvic Junction ◽  
College Hospital ◽  
Medical College ◽  
Split Renal Function

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

Comments on a case of ureteropelvic junction obstruction with late progression in an adult female

2021 ◽  
Vol 88 (3) ◽  
pp. 247-250
Author(s):  
Carlo Gandi ◽  
Angelo Totaro ◽  
Riccardo Bientinesi ◽  
Emilio Sacco
Keyword(s):  
Renal Function ◽  
Natural History ◽  
Conservative Treatment ◽  
Gold Standard ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Case Description ◽  
Diuretic Renogram ◽  
History Of

Introduction: Ureteropelvic junction obstruction is a pathology typically diagnosed in childhood. Nevertheless, some clinically silent cases may be unnoticed until adulthood. Case description: We report the case of a 53-year-old female with hydronephrosis due to ureteropelvic junction stenosis diagnosed in the adulthood, who subsequently developed obstruction with progressive worsening of renal function without symptoms. Conclusion: The natural history of ureteropelvic junction obstruction is still obscure. Diuretic renogram is the gold standard for diagnosis and follow-up of ureteropelvic junction obstruction, but is weak in predicting the evolution of the disease, especially in patients with vague symptoms. Conservative treatment of adult patient with equivocal ureteropelvic junction obstruction seems reasonable, but requires a close clinical follow-up and strict patient compliance in order to promptly identify significant obstruction.

Renal function assessment during follow-up after surgical treatment for renal cell carcinoma

2019 ◽  
Vol 18 (1) ◽  
pp. e1419-e1420
Author(s):  
P. Capogrosso ◽  
A. Larcher ◽  
F. Cianflone ◽  
F. Muttin ◽  
F. Trevisani ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Function Assessment

scholarly journals Reverse Tubularized Pelvis Flap Method for the Treatment of Long Segment Ureteropelvic Junction Obstruction

2019 ◽  
Vol 29 (2) ◽  
pp. 128-133 ◽  
Author(s):  
Haluk Sarihan ◽  
Hatice Sonay Yalçın Comert ◽  
Mustafa İmamoğlu ◽  
Dilek Basar
Keyword(s):  
Blood Supply ◽  
Ureteropelvic Junction Obstruction ◽  
Good Health ◽  
Distal Portion ◽  
Ureteropelvic Junction ◽  
Absorbable Suture ◽  
Distal Ureter ◽  
Upj Obstruction ◽  
Age Range

Objective: The most common cause of urinary obstruction is ureteropelvic junction (UPJ) obstruction. In short stenosis, a dismembered pyeloplasty is performed, but for long segment stenosis, the procedure is not well defined. We present the reverse flap ureteroplasty method, which we prepared from the pelvis for use in long segment UPJ obstruction. Methods: Between 2007 and 2016, we operated on 6 cases (4 males, 2 females) with an age range of 2–6 months. After reaching the UPJ region, depending on the length of the long segment obstruction, a flap measuring 25–35 mm in length was prepared from the pelvis so that its width would be 10–12 mm on the pelvis side and 10 mm in the distal portion. It was then reversed and tubularized with an absorbable suture over a 10-French nelaton catheter. The end of this ureter and the end of the distal ureter were spatulated and anastomosed. A double J and minivac drain were used in each case. Results: There were no complications in the postoperative period of all our patients. They were all discharged with good health. Follow-up with renal ultrasonography showed that the anteroposterior diameters were decreased and that parenchymal thicknesses had returned to normal. Secondary stenosis, flap necrosis, and retraction did not develop. Conclusion: Because the blood supply of the pelvis is increased in patients with UPJ obstruction, a reverse flap of adequate length with preserved blood supply can be achieved and tubularized. We suggest that this method will be appropriate for the treatment of long segment UPJ obstruction.

Acetabular Growth Potential in the Dysplastic and Normal Hip. A Long-Term Follow-Up

1994 ◽  
Vol 4 (1) ◽  
pp. 53-58
Author(s):  
F. Specchiulli ◽  
L. Scialpi ◽  
G. Solafino ◽  
L. Battelli ◽  
L. Nitti
Keyword(s):  
Surgical Treatment ◽  
Hip Dislocation ◽  
Normal Subjects ◽  
Growth Potential ◽  
Long Term Follow Up ◽  
Definition Of ◽  
Initial Correction

In CHD (Congenital Hip Dislocation), the elements which determine the degree and quality of acetabular growth are not clear. This has caused a great deal of controversy on the capability of development of the cotyloid cavity, hence on the indications to reconstructive surgical treatment. In order to study the behavior of che cotyloid cavity, two groups of patients were taken into consideration: normal subjects and subjects with CHD. In normal subjects the median value of the Hingelreiner angle was 19°–4'± 1° (normal limit), at 1 year old. The acetabular index decreases rapidly until becoming stable at adult values at the age of 8-10 years of age. The distinctive characteristics of the hip with spontaneous recovery from cotyloid dysplasia could be defined as follows: a) the higher critical value on average is reached after 24 months of treatment; b) once the borderline is reached, the dislocated hip evolves in the same way as the healthy hip; c) the earlier treatment is started, the sooner correction of the H angle is obtained; d) the cotyloid cavity continues to develop even after 5 years from reduction. In CHD with terminal residual dysplasia, an initial correction of the H angle is followed by a sudden interruption in acetabular development, which remains inadequate and will never reach normal values. These data allow not only the definition of the acetabular growth potential, but also the establishment of more precise indications for reconstructive surgical treatment.

scholarly journals Antenatal hydronephrosis: a five-year retrospective study

2021 ◽  
Vol 35 (3) ◽  
Author(s):  
Maria Gaia ◽  
◽  
Mariana Capela ◽  
Margarida Peixoto ◽  
Joana Borges ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Kidney Injury ◽  
Risk Groups ◽  
Mean Value ◽  
Third Trimester ◽  
Antenatal Hydronephrosis ◽  
Male Predominance ◽  
Wide Range ◽  
Definition Of

Introduction: Antenatal hydronephrosis (ANH) is common in fetal ultrasounds. Though mostly transient, it can be associated with congenital abnormalities and kidney injury. The authors went to assess the evolution of children with ANH and identify risk groups. Methods: Retrospective cohort study of children with ANH from 2013‑2017. Renal pelvis anteroposterior diameter (APD) of 4 and 7mm or more in the second and third trimester, respectively, defined diagnosis of ANH. APD also defined severity stratification. The primary out‑ comes included occurrence of urinary tract infection (UTI) and congenital anomalies of the kidney and urinary tract (CAKUT). Results: We identified 198 cases, with male predominance (76.8%) and a 2.1% incidence. It resolved antenatally in 12.1%, with a lower mean value of APD in these cases (p=0.017), and persisted in 43.4%. CAKUT were found in 8.6% of the patients. At least 1 episode of UTI occurred in 9.1% of patients during follow‑up. The degree of ANH in the 3rd trimester was related to postnatal persistence and degree (p<0.001) and the postnatal degree was related to the occurrence of UTI (p=0.008). The 3rd trimester and postnatal degree were also associated to the presence of CAKUT (p=0.036; p=0.001), although not with vesicoureteral reflux (VUR). The persistence of ANH through the 2nd and 3rd trimester was related to postnatal persistence (p=0.002) and degree (p=0.007), and the presence of CAKUT excluding VUR (p=0.034). The optimal cut‑off for the APD in the 3rd trimester to predict the occurrence of negative outcomes (CAKUT and/or UTI), through a receiver operating characteristic (ROC) curve, was 8.225mm with 76% sensitivity and 59% specificity. Discussion: ANH is frequent and reflects a wide range of conditions, requiring follow‑up. Most cases resolve spontaneously and require no further intervention other than ultrasounds. 3rd trimester and postnatal degree are related to prognosis, allowing the definition of risk groups and the improvement of patient management.

Surgical Treatment of Pancreatic Insulinomas: A Series of 15 Years

2021 ◽  
Vol 3 (3) ◽  
pp. 1-4
Author(s):  
Vanessa Rebelo dos Santos ◽  
◽  
Carlota Ramos ◽  
Rafael Cruz ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Surgical Approach ◽  
Medical Records ◽  
Surgical Intervention ◽  
Female Gender ◽  
The Body ◽  
Head Of The Pancreas ◽  
The Mean

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

scholarly journals Surgical treatment of upper urinary tract obstruction in tuberculosis of the urinary system

2021 ◽  
Vol 14 (3) ◽  
pp. 142-149
Author(s):  
A.A. Volkov ◽  
◽  
N.V. Budnik ◽  
O.N. Zuban ◽  
◽  
...  
Keyword(s):  
Urinary Tract ◽  
Surgical Treatment ◽  
Urinary Tract Obstruction ◽  
Organ Damage ◽  
Renal Tissue ◽  
Upper Urinary Tract ◽  
Reconstructive Operations ◽  
Urinary Tuberculosis

Introduction. Currently, the basis for effective treatment of urinary tuberculosis (UT) is a combination of specific chemotherapy with reasonable surgical intervention and strict follow-up of the patient. Materials and methods. This literature review presents the evolution of methods of surgical treatment of renal and upper urinary tract tuberculosis over of 127 sources found for the review, 63 were selected. Results. Since UT is a very slowly progressive disease with minimal and imperceptible symptoms, often leading to irreversible organ damage, up to 75% of patients with this pathology undergo surgery. As follows from the results of recent studies, the emphasis of surgical treatment is increasingly shifting from ablative and organ-carrying techniques to reconstructive operations. Surgery for upper urinary tract tuberculosis continues to develop, but its results in advanced cases of destruction of renal tissue often remain unsatisfactory. Conclusions. The search for new methods of reconstructive interventions, the purpose of which is to preserve functioning renal-ureteral units and improve the quality of life of patients, remains relevant.

scholarly journals Fetal Hydronephrosis, A Case Report And Review of Literature

2015 ◽  
Vol 5 (1) ◽  
pp. 36-38
Author(s):  
Parveen Akhter Shamsunnahar ◽  
Abdul Motaleb ◽  
Begum Nasrin ◽  
Fawzia Hossain ◽  
Sharmeen Mahmood ◽  
...  
Keyword(s):  
Renal Function ◽  
Review Of Literature ◽  
Fetal Intervention ◽  
Efficacy Evaluation ◽  
Fetal Hydronephrosis ◽  
Preserve Renal Function ◽  
Before And After ◽  
Antenatal Sonography

With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Hydronephrosis is one of the most commonly identified prenatal anomalies, and the severity may vary from mild to severe, depending on the underlying cause. Many cases resolve spontaneously before birth, but for those that do not, the additional prenatal evaluation can identify cases sufficiently severe to require fetal intervention to preserve renal function. The benefits of these interventions must be balanced against the significant risks of the procedures and their sequelae in long-term efficacy. Evaluation before and after birth is warranted, and factors such as cause, severity, and whether the condition is uni- or bilateral are used to formulate decisions about additional assessment and potential intervention. Here we report a case of bilateral hydronephrosis which was detected during pregnancy. After delivery right side spontaneously resolves but there was worsening of left hydronephrosis in follow up and He undergoes a left pyeloplasty at 6 months of age and does well post operatively.J. Paediatr. Surg. Bangladesh 5(1): 36-38, 2014 (January)

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