HYDRONEPHROSIS HYDRONEPHROSIS DURING PREGNANCYDURING PREGNANCY

Dr. LALITHADr. LALITHAUROLOGIST AND UROGYNECOLOGISTUROLOGIST AND UROGYNECOLOGIST

YASHODA HOSPITALYASHODA HOSPITAL

• INCIDENCE 95%

• CAUSE OF ANXIETY• PATIENTS• OBSTETRICIANS

F.A.Q.sF.A.Q.s

• CLINICAL PRESENTATION?

• INTERVENTION?• WHEN?• WHAT?

• PROGNOSIS? - MATERNAL/FETAL

ETIOPATHOGENESISETIOPATHOGENESIS

•

• PHYSIOLOGICAL

• PATHOLOGICAL

PHYSIOLOGICAL PHYSIOLOGICAL HYDRONEPHROSISHYDRONEPHROSIS

• HORMONAL

• MECHANICAL• RARE IN 1ST TRIMESTER• DILATATION OF UPPER URETER• PELVIC KIDNEY• QUADRIPEDS

PHYSIOLOGICAL PHYSIOLOGICAL HYDRONEPHROSISHYDRONEPHROSIS

• RIGHT > LEFT

• DEXTROROTATION

• RIGHT OVARIAN VESSELS

• LEFT – PROTECTION BY SIGMOID COLON

PATHOLOGICAL PATHOLOGICAL HYDRONEPHROSISHYDRONEPHROSIS

• CALCULI• PUJ OBSTRUCTION• OBSTRUCTED MEGA URETER• VU-REFLUX• NEUROGENIC BLADDER - RARE

CLINICAL PRESENTATIONCLINICAL PRESENTATION

• ASYMPTOMATIC• PAIN – DULL / COLICKY• VOMITING• FEVER WITH CHILLS• HEMATURIA• OLIGURIA / ANURIA

DIAGNOSISDIAGNOSIS

• ULTRASONOGRAPHY• HYDRONEPHROSIS• HYDROURETER – UPPER / LOWER• CALCULI – RENAL / PUJ / URETER• PARENCHYMAL THICKNESS• URETERIC JET• RENAL RESISTIVE INDEX

DIAGNOSISDIAGNOSIS

• IVP – OBSOLETE

• MR UROGRAPHY• TO DIFFERENTIATE PHYSIOLOGICAL FROM CALCULUS• HYDRONEPHROSIS

• DOUBLE KINK SIGN – SPINDLE SHAPED PELVIC URETER

MANAGEMENTMANAGEMENT

• CONSERVATIVE• SCREENING FOR BACTERIURIA• RISK OF PYELONEPHRITIS IN 28-30%• ANTIBIOTICS / ANALGESICS

• PERIODIC URINE CULTURES• SERIAL CREATININE / USG MONITORING

• SUPPRESSANT ANTIBIOTIC THERAPY

INDICATIONS FOR SURGICAL INDICATIONS FOR SURGICAL INTERVENTIONINTERVENTION

• SYMPTOMATIC PATIENTS NOT RESPONDING TO DRUGS.

• RECURRENT PYELONEPHRITIS

• OLIGURIA / ANURIA

• INCREASED S.CREAT [>0.8]

• PROGRESSIVE HYDRONEPHROSIS

TYPE OF INTERVENTIONTYPE OF INTERVENTION

• CYSTOSCOPY & DJ STENTING

• URETEROSCOPIC STONE REMOVAL

• URETEROSCOPIC PUSH BACK & DJ STENTING

• USG GUIDED PCN

• ESWL CONTRAINDICATED

OUR EXPERIENCEOUR EXPERIENCE

• 96 CASES IN LAST 5 YEARS• 18 REQUIRED SURGICAL

INTERVENTION• 6 – PHYSIOLOGICAL• 9 – CALCULUS 6 – LOWER URETER 3 - UPPER URETER / PUJ 3 – PUJ OBSTRUCTION - BILAT.

FOLLOW UPFOLLOW UP

• DJ STENT REMOVAL DEPENDS ON INDICATION• 3 WEEKS FOR URSL• 6 WEEKS PP FOR PHYSIOLOGICAL

• FU MANDATORY IN INTERVAL PERIOD• SCREENING USG / IVP

AIMAIM

• BYPASS OBSTRUCTION

• RELEIVE STASIS

• IMPROVE MATERNAL & FETAL PROGNOSIS