The document discusses hydronephrosis during pregnancy, including its incidence, causes, clinical presentation, diagnosis, and management. It highlights the physiological and pathological factors contributing to the condition, along with indications for surgical intervention in symptomatic cases. The author's experience with cases over five years is presented, emphasizing the need for monitoring and follow-up to improve maternal and fetal prognosis.

1. HYDRONEPHROSISHYDRONEPHROSIS
DURING PREGNANCYDURING PREGNANCY
Dr. LALITHADr. LALITHA
UROLOGIST AND UROGYNECOLOGISTUROLOGIST AND UROGYNECOLOGIST
YASHODA HOSPITALYASHODA HOSPITAL

2. • INCIDENCE 95%
• CAUSE OF ANXIETY
• PATIENTS
• OBSTETRICIANS

3. F.A.Q.sF.A.Q.s
• CLINICAL PRESENTATION?
• INTERVENTION?
• WHEN?
• WHAT?
• PROGNOSIS? - MATERNAL/FETAL

4. ETIOPATHOGENESISETIOPATHOGENESIS
•
• PHYSIOLOGICAL
• PATHOLOGICAL

5. PHYSIOLOGICALPHYSIOLOGICAL
HYDRONEPHROSISHYDRONEPHROSIS
• HORMONAL
• MECHANICAL
• RARE IN 1ST
TRIMESTER
• DILATATION OF UPPER URETER
• PELVIC KIDNEY
• QUADRIPEDS

6. PHYSIOLOGICALPHYSIOLOGICAL
HYDRONEPHROSISHYDRONEPHROSIS
• RIGHT > LEFT
• DEXTROROTATION
• RIGHT OVARIAN VESSELS
• LEFT – PROTECTION BY SIGMOID COLON

7. PATHOLOGICALPATHOLOGICAL
HYDRONEPHROSISHYDRONEPHROSIS
• CALCULI
• PUJ OBSTRUCTION
• OBSTRUCTED MEGA URETER
• VU-REFLUX
• NEUROGENIC BLADDER - RARE

8. CLINICAL PRESENTATIONCLINICAL PRESENTATION
• ASYMPTOMATIC
• PAIN – DULL / COLICKY
• VOMITING
• FEVER WITH CHILLS
• HEMATURIA
• OLIGURIA / ANURIA

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

12. DIAGNOSISDIAGNOSIS
• IVP – OBSOLETE
• MR UROGRAPHY
• TO DIFFERENTIATE PHYSIOLOGICAL FROM CALCULUS
• HYDRONEPHROSIS
• DOUBLE KINK SIGN – SPINDLE SHAPED PELVIC URETER

20. MANAGEMENTMANAGEMENT
• CONSERVATIVE
• SCREENING FOR BACTERIURIA
• RISK OF PYELONEPHRITIS IN 28-30%
• ANTIBIOTICS / ANALGESICS
• PERIODIC URINE CULTURES
• SERIAL CREATININE / USG MONITORING
• SUPPRESSANT ANTIBIOTIC THERAPY

21. INDICATIONS FOR SURGICALINDICATIONS FOR SURGICAL
INTERVENTIONINTERVENTION
• SYMPTOMATIC PATIENTS NOT RESPONDING TO
DRUGS.
• RECURRENT PYELONEPHRITIS
• OLIGURIA / ANURIA
• INCREASED S.CREAT [>0.8]
• PROGRESSIVE HYDRONEPHROSIS

22. TYPE OF INTERVENTIONTYPE OF INTERVENTION
• CYSTOSCOPY & DJ STENTING
• URETEROSCOPIC STONE REMOVAL
• URETEROSCOPIC PUSH BACK & DJ STENTING
• USG GUIDED PCN
• ESWL CONTRAINDICATED

23. 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.

36. 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

37. AIMAIM
• BYPASS OBSTRUCTION
• RELEIVE STASIS
• IMPROVE MATERNAL & FETAL PROGNOSIS