Antenatal HydronephrosisAntenatal HydronephrosisCauses and ManagementCauses and Management
DiagnosisDiagnosis• UltrasoundUltrasound• Anterior-posterior diameter usually < 6 mmAnterior-posterior diameter usually < ...
CausesCauses• PUJ ObstructionPUJ Obstruction• VURVUR• Megaureter/UVJ ObstructionMegaureter/UVJ Obstruction• Posterior uret...
ManagementManagement• < 5% have renal insufficiency< 5% have renal insufficiency• Majority do not require any treatmentMaj...
PUJPUJ• US and MAG 3US and MAG 3• Conservative:Conservative: AP diam < 20 – 30 mmAP diam < 20 – 30 mmsplit function > 40%s...
ManagementManagement• Hydro with normal ureter or bladderHydro with normal ureter or bladder Unilateral - > 15 mm ---- MA...
• Bilateral or Unilat with ureteric or bladder abnormalBilateral or Unilat with ureteric or bladder abnormal Postnatal US...
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Antenatal hydronephrosis

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Antenatal hydronephrosis

  1. 1. Antenatal HydronephrosisAntenatal HydronephrosisCauses and ManagementCauses and Management
  2. 2. DiagnosisDiagnosis• UltrasoundUltrasound• Anterior-posterior diameter usually < 6 mmAnterior-posterior diameter usually < 6 mm• < 15 mm unlikely to be significant obstruction posing< 15 mm unlikely to be significant obstruction posingthreat to functionthreat to function• > 50 mm associated with diminished function> 50 mm associated with diminished function• Ureteric dilatation is abnormal and ureter of normal calibreUreteric dilatation is abnormal and ureter of normal calibrecannot be seencannot be seen• Gestational age importantGestational age important
  3. 3. CausesCauses• PUJ ObstructionPUJ Obstruction• VURVUR• Megaureter/UVJ ObstructionMegaureter/UVJ Obstruction• Posterior urethral valvesPosterior urethral valves
  4. 4. ManagementManagement• < 5% have renal insufficiency< 5% have renal insufficiency• Majority do not require any treatmentMajority do not require any treatment• Depends whether unilateral or bilateralDepends whether unilateral or bilateral• US 24-72 hoursUS 24-72 hours
  5. 5. PUJPUJ• US and MAG 3US and MAG 3• Conservative:Conservative: AP diam < 20 – 30 mmAP diam < 20 – 30 mmsplit function > 40%split function > 40%• Intervention:Intervention: SymptomaticSymptomatic< 40% split function if AP > 30 mm< 40% split function if AP > 30 mmfailure of conservative (func or dilat)failure of conservative (func or dilat)prolonged asympt obstructionprolonged asympt obstruction
  6. 6. ManagementManagement• Hydro with normal ureter or bladderHydro with normal ureter or bladder Unilateral - > 15 mm ---- MAG3Unilateral - > 15 mm ---- MAG3 Bilateral --- MCUG ----- VUR/PUV/NormalBilateral --- MCUG ----- VUR/PUV/Normal Unilateral - < 15 mm ----- repeat US @ 3/12 or if InfxnUnilateral - < 15 mm ----- repeat US @ 3/12 or if Infxn---MCUG---MCUG
  7. 7. • Bilateral or Unilat with ureteric or bladder abnormalBilateral or Unilat with ureteric or bladder abnormal Postnatal US @ 24 – 72 hours and MCUGPostnatal US @ 24 – 72 hours and MCUG PUV/VUR ----- DMSAPUV/VUR ----- DMSA Neither ---- Megaureter or PUJ ----- MAG3Neither ---- Megaureter or PUJ ----- MAG3

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