Hydronephrosis or obstruction of UPJ
Hydronephrosis is an extensionrenal collecting system (especially the pelvis) that occurs due to the presence of barriers to entry of urine at the junction of the pelvis and ureter (in pyeloureteral segment).
Urinary tract include (top to bottom), renal calyx, renal pelvis, ureter, bladder, urethra. Pelvis and cups together constitute the renal collecting system.
Pronounced obstacle outflow of urine from the kidneylead to a significant expansion of the renal pelvis and often to permanent impairment of kidney function. The degree of renal collecting system expansion pressure is proportional to urine and it varies widely.
A small obstacle urine output, causing a moderate expansion of the renal pelvis (pyeloectasia) and is usually not accompanied by impaired renal function, and only increases the risk of pyelonephritis.
Causes of hydronephrosis in children
In children, the vast majority of casescommon congenital hydronephrosis ICD due to anatomical reasons. There are external and internal causes of hydronephrosis. The internal reason - congenital narrowing of the ureter, due to underdevelopment of its lumen, occurs more often than others. External causes - abnormal discharge of the ureter and renal pelvis of an additional vessel, causing compression of the ureter.
Manifestations, hydronephrosis symptoms
Hydronephrosis is part of a group of diseasesaccompanied by the expansion of the renal pelvis (pyeloectasia), which is easy to detect by ultrasound of the fetus. Therefore, most of hydronephrosis detected in utero. If the diagnosis has not been established before the child's birth, hydronephrosis may appear blood in the urine (hematuria), urinary tract infection, abdominal pain, or upon detection of volumetric formation in the abdominal cavity.
Research in hydronephrosis
The first step in the diagnosis of hydronephrosis is the wayFetal ultrasound. The collective system of kidney visible by ultrasound 15 weeks since the prenatal period. The first sign of ultrasound is an extension of the pelvis. If after birth the expansion of the renal pelvis is maintained, the pediatric urologist decide on the need for a more thorough urological examination. If you suspect the presence of hydronephrosis child must pass the following tests:
Ultrasound of the kidneys and the bladder before and after urination. on US specialist can see the signsdamage to the renal parenchyma distinguish mild, moderate-to-severe hydronephrosis. When questionable results of ultrasound can be performed with water load and diuretics, can more accurately assess the degree of obstruction of UPJ.
voiding cystourethrography - Radiopaque examination of the bladder and urethra performed for suspected vesicoureteral reflux or hindered the flow of urine from the bladder.
Excretory (intravenous) urography - After intravenous radiopaque substance excreted by the kidneys, and their collective systems become visible on X-rays. A study to evaluate the degree of obstruction.
Nefrostsintigrafiya - Radioisotope study of the kidneys. Used to evaluate kidney function and the degree of disturbance of outflow of urine.
Based on these studies specialistIt must decide how serious the obstruction of UPJ, whether it is a threat to the kidney or may resolve on their own. In newborns diagnosed often becomes apparent only after 3-4 weeks after birth. During the first 3 weeks after birth water metabolism in the body of the newborn and kidney function are changed considerably, and pelvis dimensions change with them.
Treatment of hydronephrosis
Initial symptoms often disappear hydronephrosison their own, but sometimes progress. Displaying surveillance specialist with the performance of ultrasound 2-4 times a year, in the first 3 years of life, and once a year at an older age.
The average degree of hydronephrosis, starting with2 degrees of hydronephrosis, may have both positive and negative dynamics. With increasing expansion of the pelvis in the process of observation is necessary to conduct surgery. US in the first year of life with an average degree of hydronephrosis are conducted every 2-3 months.
Severe hydronephrosis with a sharp violation of the outflow of urine from the kidney requires surgery without delay.
Operation in hydronephrosis
Operation in hydronephrosis is excisionthe narrow portion of the ureter and the formation of a new broad connection (anastomosis, fistula) between the ureter and renal pelvis. Called Operation - pyeloplasty.
The most common method of operation -pyeloplasty for Hines-Andersen. Constriction of the ureter is usually located directly next to the renal pelvis. After cutting off the ureter, it is closest to the kidney portion is cut lengthwise, then cut the edges of the ureter with sewn edges symmetric (congruent) longitudinal incision in the pelvis. Usually after the surgery left a tube drawn through the junction of the ureter and renal pelvis to provide a uniform gap junction and avoid sticking and deformation. The second end of the tube can be removed in the bladder (internal drainage stent) or through the kidney tissue (catheter-mah).
The duration of finding the child in the hospital after surgery
The duration of the child's stay in hospitalafter the operation depends on the way of diversion of the operated kidneys. When installing internal drainage stent, additional drainage to drain urine from the kidney is not required, and a stationary post-operative period is shortened to 5-9 days. The stent is removed in a month - half after the operation through a thin tool, introduced on the urethra.
If you do not set the stent during surgery,and the catheter blank, which is expelled through the kidney, which is set parallel to the pipe-drainage (nephrostomy) to ensure the free flow of urine from the operated kidney. In this case, a longer stay in hospital child - about 3 weeks. Selecting urinary diversion is done by the surgeon during surgery.
Features of treatment and anesthesia are determined by the operating surgeon to discuss
Efficiency is about pyeloplasty92-95%. After performing the kidney function is almost always improved in a number of observations and reaches healthy kidney function. At the same time, structural changes in the kidney (deformation cups, reducing the thickness of the parenchyma) can be stored. Especially significant residual changes are observed in a pronounced hydronephrosis.
Prediction for newborn hydronephrosis
The method allows to determine how it willdevelop hydronephrosis newborn, does not currently exist. Therefore, the most correct approach is to monitor the state of the kidneys in the dynamics of an experienced specialist urologist. The main method of assessment is used in the follow-ultrasound. The difficulty of forecasting the development of hydronephrosis in the newborn is determined by unstable exchange water, changing kidney function, as well as the possibility of ripening (maturatsii) its organs and tissues. These processes may lead to the disappearance of extension or pelvic stabilization of its dimensions. At the same time, at long intervals between inspections (over 2 months) may miss the start of the deterioration of kidney status and being late with your surgery.