Outcome-of-antenatally-diagnosed-hydronephrosis - Outcome...

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Unformatted text preview: Outcome of antenatally diagnosed 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 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 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 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 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 Materials and methods The patients were followed up throughout the course of pregnancy and after birth. Post natal evaluation included ultrasound (1­3 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 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 <15mm USG / 3 monthly followup Bilateral, HUN, Bladder abnormality USG at 24 Hrs AP diameter 15-25mm 25-40mm Monthly USG DTPA Improves Follow up >40mm surgery MCU Intervention (PUV, Ureterocele) RESULTS RESULTS 2003­ 2008 Total number of patients registered ­ 140 Defaulters for follow up ­ 24 Total included patients ­ 116 Group I Group II ­ 78 ­ 38 (Isolated hydro) (HUN, bilatera) Fetal Ultrasound Fetal Ultrasound Unilateral hydronephrosis Post Natal Ultrasound Post Natal Ultrasound Post natal USG Post natal HUN OUTCOME OF ANTENTAL HYDRONEPHROSIS OUTCOME OF ANTENTAL HYDRONEPHROSIS Group I­ Isolated hydronephrosis (n= 78) Required surgery 7 (9%) 80 70 60 50 40 30 Group II – HUN, Bilateral 20 (n=38) 10 Required surgery 21 (55%)0 Group I Fisher’s exact test P = 0.002 (significant) Group II Group 1: Isolated Hydronephrosis (PUJ) Group 1: Isolated Hydronephrosis (PUJ) 7/78 required surgery Size Total number Surgery required < 15 mm 55 NIL 16 – 25 mm 12 1 26 – 40 mm 7 2 > 40 mm 4 4 Chi-square test P < 0.001 Outcome in group II Outcome in group II 21/38 required surgery Cause Total number Surgery required PUV 12 12 VUR 22 5 VUJ obstruction 3 3 Ureterocele etc 1 1 Conclusions 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 Conclusions The parents of fetuses with isolated fetal hydronephrosis could be favorably counselled. THANK YOU THANK YOU ...
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This note was uploaded on 01/16/2012 for the course BI 200 taught by Professor Potter during the Fall '11 term at Montgomery College.

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