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

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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
lt15mm
15-25mm
25-40mm
gt40mm
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 (n38)
• Required surgery 21 (55)
• Fishers exact test
• P 0.002 (significant)

Group I Group II
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Group 1 Isolated Hydronephrosis (PUJ) 7/78
required surgery
Size Total number Surgery required
lt 15 mm 55 NIL
16 25 mm 12 1
26 40 mm 7 2
gt 40 mm 4 4
Chi-square test P lt 0.001
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Outcome in group II21/38 required surgery
Cause Total number Surgery required
PUV 12 12
VUR 22 5
VUJ obstruction 3 3
Ureterocele etc 1 1
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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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THANK YOU