Outcome of antenatally diagnosed hydronephrosis our series
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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.

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Outcome of antenatally diagnosed hydronephrosis our series l.jpg

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 l.jpg
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.


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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.


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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.


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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.


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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.


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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.


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Fetal hydronephrosis

Unilateral, isolated (PUJ)

Bilateral, HUN, Bladder abnormality

USG at 24 Hrs

USG at 72 Hrs

AP diameter

MCU

<15mm

15-25mm

25-40mm

>40mm

Intervention

(PUV, Ureterocele)

USG /

3 monthly

followup

Monthly

USG

DTPA

surgery

Improves  Follow up


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RESULTS

  • 2003- 2008

  • Total number of patients registered - 140

  • Defaulters for follow up - 24

  • Total included patients - 116

  • Group I (Isolated hydro) - 78

  • Group II (HUN, bilatera) - 38


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Fetal Ultrasound

Unilateral hydronephrosis


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Post Natal Ultrasound

Post natal USG

Post natal HUN


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OUTCOME OF ANTENTAL HYDRONEPHROSIS

  • Group I- Isolated hydronephrosis (n= 78)

    • Required surgery 7 (9%)

  • Group II – HUN, Bilateral (n=38)

    • Required surgery 21 (55%)

  • Fisher’s exact test

    P = 0.002 (significant)

Group I Group II


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Group 1: Isolated Hydronephrosis (PUJ)7/78 required surgery

Chi-square test P < 0.001


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Outcome in group II21/38 required surgery


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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


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Conclusions

The parents of fetuses with isolated fetal hydronephrosis could be favorably counselled.



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