Transcript Outcome of antenatally diagnosed hydronephrosis
Outcome of antenatally diagnosed hydronephrosis- our series
VIJAYANAND , VENKATA SAI, RAMESH BABU S, SUNIL SHROFF,RAJAMANIKAM Paediatric Urology & Paediatric Nephrology Units Departments of Radiology & Urology SRI RAMACHANDRA MEDICAL COLLEGE AND RESEARCH INSTITUTE, CHENNAI
INTRODUCTION Ultrasonogram has become a routine imaging modality to diagnose congenital anomalies.
Hydronephrosis is one of the common anomaly detected in the fetus Incidence of antenatally detected hydronephrosis 2 – 4 % Antenatal diagnosis of hydronephrosis causes a significant distress to the parents during pregnancy.
INTRODUCTION Antenatal counseling is being done regularly these days. It is important to know the natural history of the disease to give the parents an idea of what they can expect .
The existing literature on the outcome of antenatal hydronephrosis are unclear.
AIMS AND OBJECTIVES To asses the outcome of antenatally diagnosed hydronephrosis in our series of patients. To find out which children would require early surgical intervention, and who would require follow up evaluation.
To create a guideline for antenatal counseling based on our findings.
Materials and methods The study was conducted for 5 years from 2003 to 2008 .
All the patients who were seen in our hospital with antenatally diagnosed hydronephrosis were included in the study.
Materials and methods The patients were followed up throughout the course of pregnancy and after birth.
Post natal evaluation included ultrasound (1-3 monthly) Whenever indicated MCU, DTPA performed Patients were followed from 1 to 4 years with a median follow up of 2.4 years.
Patient Groups The patients were divided into two groups based on fetal USG, Group I Isolated unilateral hydronephrosis.
Group II – Hydroureter, bilateral involvement, bladder wall thickening.
The outcome between groups were compared.
Fetal hydronephrosis Unilateral, isolated (PUJ) USG at 72 Hrs AP diameter <15mm 15-25mm 25-40mm >40mm Bilateral, HUN, Bladder abnormality USG at 24 Hrs MCU USG / 3 monthly followup Monthly USG DTPA Improves Follow up
surgery
Intervention (PUV, Ureterocele)
RESULTS 2003- 2008 Total number of patients registered Defaulters for follow up Total included patients Group I (Isolated hydro) Group II (HUN, bilatera) - 140 - 24 - 116 - 78 - 38
Fetal Ultrasound
Unilateral hydronephrosis
Post Natal Ultrasound
Post natal USG Post natal HUN
OUTCOME OF ANTENTAL HYDRONEPHROSIS Group I- Isolated hydronephrosis (n= 78) Required surgery 7 (9%)
40
Group II – HUN, Bilateral (n=38) Required surgery 21 (55%)
30 20 10 0 80 70 60 50
Fisher’s exact test P = 0.002 (significant) Group I Group II
Group 1: Isolated Hydronephrosis (PUJ) 7/78 required surgery
Size < 15 mm Total number 55 Surgery required NIL 16 – 25 mm 26 – 40 mm > 40 mm 12 7 4 Chi-square test P < 0.001
1 2 4
Cause PUV VUR VUJ obstruction Ureterocele etc
Outcome in group II 21/38 required surgery
Total number 12 22 3 1 5 3 Surgery required 12 1
Conclusions
Group 1: Isolated fetal hydronephrosis Vast majority are minimal hydronephrosis which resolve spontaneously Only 9% require surgery Group II: Ureterohydronephrosis, Bilateral etc 55% required intervention PUV, VUJ, Ureterocele etc
Conclusions
The parents of fetuses with isolated fetal hydronephrosis could be favorably counselled.