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HYDRONEPHROSIS DURING PREGNANCY Dr. LALITHA UROLOGIST AND UROGYNECOLOGIST YASHODA HOSPITAL


• INCIDENCE

95%

• CAUSE OF ANXIETY • PATIENTS • OBSTETRICIANS


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


ETIOPATHOGENESIS • •

PHYSIOLOGICAL

PATHOLOGICAL


PHYSIOLOGICAL HYDRONEPHROSIS • HORMONAL • MECHANICAL • RARE IN 1 TRIMESTER ST

• • •

DILATATION OF UPPER URETER PELVIC KIDNEY QUADRIPEDS


PHYSIOLOGICAL HYDRONEPHROSIS • RIGHT > LEFT •

DEXTROROTATION

RIGHT OVARIAN VESSELS

LEFT – PROTECTION BY SIGMOID COLON


PATHOLOGICAL HYDRONEPHROSIS • • • • •

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


CLINICAL PRESENTATION • • • • • •

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


DIAGNOSIS • ULTRASONOGRAPHY • HYDRONEPHROSIS • • • • •

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


DIAGNOSIS • IVP – OBSOLETE • MR UROGRAPHY • TO DIFFERENTIATE PHYSIOLOGICAL FROM CALCULUS •

HYDRONEPHROSIS

DOUBLE KINK SIGN – SPINDLE SHAPED PELVIC URETER


MANAGEMENT • 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 INTERVENTION • SYMPTOMATIC PATIENTS NOT RESPONDING TO DRUGS. • RECURRENT PYELONEPHRITIS • OLIGURIA / ANURIA • INCREASED S.CREAT [>0.8] • PROGRESSIVE HYDRONEPHROSIS


TYPE OF INTERVENTION • CYSTOSCOPY & DJ STENTING • URETEROSCOPIC STONE REMOVAL • URETEROSCOPIC PUSH BACK & DJ STENTING • USG GUIDED PCN •

ESWL CONTRAINDICATED


OUR 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 UP • DJ STENT REMOVAL DEPENDS ON INDICATION • 3 WEEKS FOR URSL • 6 WEEKS PP FOR PHYSIOLOGICAL • FU MANDATORY IN INTERVAL PERIOD • SCREENING USG / IVP


AIM •

BYPASS OBSTRUCTION

RELEIVE STASIS

IMPROVE MATERNAL & FETAL PROGNOSIS


Hydro nephrosis during pregnancy