Intermittent Hydronephrosis Research Articles

Pathological characteristics analysis of children with intermittent and persistent hydronephrosis due to uretero-pelvic junction obstruction.

To analyze from a pathological perspective the differences between intermittent and persistent hydronephrosis in children with uretero-pelvic junction obstruction. 23 children who underwent unilateral dismembered pyeloplasty (Anderson-Hynes operation) for intermittent hydronephrosis from September 2017 to March 2024 were included in the observation group. They were compared with a control group consisting of 23 children with persistent hydronephrosis matched for age, gender, and affected side. All children had the narrowed segment surgically excised during the operation, while other obstructive causes (such as polyps, crossing vessels, or tumor compression) were excluded. The specimens were analyzed for muscle and collagen content using Masson's trichrome staining, and the collagen-to-muscle ratio (CMR) was calculated. The number of Cajal-like cells was quantified with c-kit immunohistochemical staining. For all slides, 10 random fields of view were selected under a 400× optical microscope to record pathological data and calculate mean values. Pathological indicators between the two groups were compared using the T-test and the Chi-square test, with P < 0.05 considered statistically significant. The observation group showed a significant difference in the number of fields with low, medium, and high densities of Cajal-like cells compared to the control group [132 (57.4%) vs. 173 (75.2%); 70 (30.4%) vs. 38 (16.5%); 28(12.2%) vs. 19 (8.3%), P < 0.001]. The uretero-pelvic junction in children with intermittent hydronephrosis had lower collagen content, higher muscle content, and a more regular arrangement. The collagen-muscle ratio was significantly lower than that in children with persistent hydronephrosis [(1.59 ± 0.65) vs. (3.98 ± 1.19), P < 0.001]. Compared with persistent hydronephrosis, the narrowed segment at the uretero-pelvic junction in children with intermittent hydronephrosis has a higher density of Cajal-like cells; lower collagen content, and higher muscle content (lower collagen-muscle ratio).

Laparoscopic treatment of vasorenal hydronephrosis in children using aberrant renal vessel transposition

The purpose of this article is to assess the immediate results of laparoscopic transposition of aberrant renal vessels as an effective alternative to pyeloplasty in the treatment of children with external obstruction of the pyeloureteral junction. Material and methods. The laparoscopic vascular transposition technique was used in 3 children with hydronephrosis caused by aberrant renal vessels. The preoperative diagnostic examination included: ultrasound / Doppler scanning, radioisotope renal scanning and contrast computed urography. Renoscintigraphy showed that all patients had intermittent hydronephrosis (24–36 mm) and an obstructive pattern. In order to select patients in whom vascular transposition is possible, the diuretic loading test was made at the beginning of the surgery. During the surgery, accessory renal vessels were mobilized and moved upward, where they were fixed by "wrapping" with renal pelvis tissue. Results. The median operative time was 59.0±10.2 minutes, and the median hospital stay was 3.6±0.5 days. There were no complications at the early observation period. At the follow-up (6.0–24.0 months), all patients showed a decrease in the degree of hydronephrosis and an improvement in excretory function at the renogram. Conclusion. Preliminary results of the study have demonstrated safety and efficacy of laparoscopic repositioning of aberrant renal vessels for the treatment of hydronephrosis. A careful selection of patients through intraoperative functional tests is an important step to confirm indications for this procedure and to maintain its high success rate. Any concerns about the presence of additional internal stenosis of the pyeloureteral junction, of course, should transform this surgical intervention into the classic pyeloplasty.

Laparoscopic approach for intermittent hydronephrosis caused by primary ureteral fibroepithelial polyps in children

ObjectiveTo summarize the diagnosis and treatment experience of children with intermittent hydronephrosis caused by ureteral fibroepithelial polyp (UFP).MethodsFrom 2017 to 2020, cases of hydronephrosis caused by ureteral polyp in Anhui...

The clinical manifestations of intermittent hydronephrosis and their relationship with renal function in pediatric patients

Most patients with intermittent hydronephrosis have preserved differential renal function (DRF), while others already have impaired DRF at diagnosis. We summarized the clinical manifestations of intermittent hydronephrosis to elucidate what may be related to DRF loss. We retrospectively reviewed patients presenting to our department with unilateral Dietl's Crisis between January 2014 and December 2017. Clinical characteristics were collected, including age of first onset, time of onset, duration of the longest single episodes and whether the patient had prenatally detected hydronephrosis. Ultrasonographic (US) parameters included anteroposterior diameter (APD) during the symptomatic and asymptomatic period. Dynamic renograms (DR) were reviewed to obtain preoperative DRF. A total of 150 patients met the selective criteria. Of the 128 patients whose mother had regular obstetric ultrasounds during pregnancy, 50 (39.06%) had prenatally detected pelvic dilation. The mean age of the first attack was earlier in the prenatally detected hydronephrosis group than in the postnatally detected group (4.58 vs 5.87, p=0.002). The mean preoperative DRF was 41.03% in all of the patients. The patients whose DRFs were below 40% had longer durations of single attacks than those over 40%. The former group also had larger APD during the symptomatic periods than the latter group. The risk of DRF < 40% was higher in the patients whose APD at attack was greater than 35mm (OR=5.111, χ2=12.899, p<0.001). The attack times, waiting time before the surgery and age of the first onset had no association with preoperative DRF. Our study first found that in patients with Dietl's Crisis, the APD during the symptomatic periods and the longest duration of the attack were associated with DRF loss. But the retrospective nature of our study limited us to understand the relationship between DRF and total duration of all attacks. This study revealed that children with prenatal hydronephrosis could develop Dietl's Crisis at early ages. A longer duration of attack and larger APD during the attack were associated with impaired DRF.

Idronefrosi intermittente, dolore addominale e vomito: non è vomito ciclico!

Intermittent hydronephrosis, abdominal pain, and vomiting: it is not cyclic vomiting!

Abdominal pain as a result of intermittent hydronephrosis.

We report a minority of cases presented with abdominal pain due to intermittent hydronephrosis, to improve the recognition of this condition. We retrospectively studied 1152 children complained of abdominal pain in our center from January 2010 to December 2015. Also, we analyzed the clinical presentation, treatment experience, examination results, and image features in detail. 14 patients received a diagnosis of intermittent hydronephrosis including 11 boys and 3 girls. 9 patients were affected on the left kidney and other 5 on the right side. All children presented recurrent abdominal pain, and the ultrasound images varied during different stages. All patients had been misdiagnosed and delayed treatment. Abdominal pain caused by intermittent hydronephrosis is easily misdiagnosed; all preschool children with a history of recurrent abdominal pain should be suspected of this condition.

Minimally Invasive Treatment of Pediatric Extrinsic Ureteropelvic Junction Obstruction by Crossing Polar Vessels: Is Vascular Hitching a Definitive Solution? Report of a Multicenter Survey.

This article aimed to evaluate the outcome of laparoscopic vascular hitch (VH) as an effective alternative to dismembered pyeloplasty in the treatment of children with extrinsic ureteropelvic junction obstruction (UPJO) by crossing vessels (CVs), by reporting the experience of three Italian centers of Pediatric Surgery. From 2006 to 2014, 54 children (18 girls and 36 boys, average age 10.7 years) affected by suspected extrinsic UPJO by CV were treated in three different institutions: 51 patients underwent laparoscopic VH, while 3 patients, in which a coexisting intrinsic etiology of UPJO was doubtful, underwent laparoscopic dismembered pyeloplasty. Preoperative diagnostic workup included: ultrasound (US)/Doppler scan, mercaptoacetyltriglycine (MAG3)-renal scan, and functional-magnetic-resonance-urography (fMRU). Symptoms at presentation were recurrent abdominal/flank pain and hematuria. All patients presented intermittent hydronephrosis (range 18-100 mm) on US and an obstructive pattern on MAG3 renogram. Average operative time was 108 minutes, and average hospital stay was 1.8 days. As for complications, we reported a small abdominal wall hematoma and a high UPJ distortion without obstruction in 2 patients, not requiring reintervention (grade I Clavien-Dindo). At follow-up (range 12-96 months), all patients reported resolution of symptoms, decrease in the hydronephrosis grade, and improved drainage on MAG3 renogram. Our results demonstrated the safety and efficacy of laparoscopic VH for treatment of extrinsic UPJO by CV, registering excellent outcomes in a very selected patient population. The careful selection of patients through intraoperative assessment of anatomical and functional aspects is a crucial step to confirm indications for VH and maintain a high success rate with the procedure. We believe that any concerns regarding the coexistence of intrinsic stenosis should certainly lead to opening the collecting system and to performing a classic dismembered pyeloplasty.

Objective improvement in renal function post-Dietl's crisis: Documented on renal dynamic scintigraphy.

Dietl's crisis is one of the treatable causes of intermittent abdominal pain. The pain is due to acute hydronephrosis that leads to stretching of the pelvis. The most common cause of this intermittent hydronephrosis is aberrant renal vessel at lower pole that causes pelvi-ureteric junction obstruction.(PUJO). High insertion of the ureter is one of the other rare causes. We present a case of 5-year-old boy with intermittent abdominal pain and distension with ultrasonography features of gross left hydronephrosis. Renal dynamic scan.(RDS) with ethylene dicysteine showed negligible functioning left kidney. On third follow-up day, the patient passed a lot of urine with decrease in abdominal pain and distension. Then, again the patient was sent to us 8.days after the first study for repeat RDS, which showed significant improvement in function and decreased in the size of left kidney though with persistent PUJO. On exploration high insertion of the ureter at pelvis was found to be the cause and was treated.

Intermittent hydronephrosis in childhood

Intermittent pelviureteric junction obstruction, and its consequence,intermittent hydronephrosis is a difficult condition to identify. The renal collecting system is not dilated between the episodes of abdominal pain attacks and a prompt investigation is hard to carry out during the time of painful crisis. Therefore, most of the patients are initially misdiagnosed. The aim of the study was to assess the occurrence and the clinical characteristics of this phenomenon in children operated in the Department of Urological Surgery, Heim Pál Children Hospital, Budapest, Hungary. Medical records of children operated for hydronephrosis between 2008 and 2012 were reviewed. The occurrence rate and clinical features of intermittent hydronephrosis were analyzed. 76 children were operated for pelviureteric junction obstruction, of which 10 met the criteria of intermittent hydronephrosis. The average interval between the onset of symptoms and the final diagnosis was 2 years and 4 months. In 7 patients pyeloplasty, and in 3 patients nephrectomy were performed. Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys.

Unilateral Hydronephrosis and Renal Damage after Acute Leukemia

A 14-year-old boy presented with asymptomatic right hydronephrosis detected on routine yearly ultrasound examination. Previously, he had at least two normal renal ultrasonograms, 4 years after remission of acute myeloblastic leukemia, treated by AML-BFM-93 protocol. A function of the right kidney and no damage on the left was confirmed by a DMSA scan. Right retroperitoneoscopic nephrectomy revealed 3 renal arteries with the lower pole artery lying on the pelviureteric junction. Histologically chronic tubulointerstitial nephritis was detected. In the pathogenesis of this severe unilateral renal damage, we suspect the exacerbation of deleterious effects of cytostatic therapy on kidneys with intermittent hydronephrosis.

Renal Ultrasonography Should Be Done Routinely in Children with First Urinary Tract Infections

To assess the consequences of renal ultrasonography (RUS) in the treatment of children younger than 5 years of age with a first febrile urinary tract infection. We retrospectively reviewed the results of imaging studies, including RUS, computed tomography, and voiding cystourethrography in children with a first febrile urinary tract infection during a 2-year period. Children with known urologic anomalies, other underlying diseases, or simultaneous combined illnesses were excluded. Children with nephromegaly were diagnosed with acute lobar nephronia by computed tomography. A total of 390 children were included in this study. Of the 390 children, 112 (28.7%) had abnormal RUS findings. The children with abnormal RUS findings of nephromegaly, small kidney, intermittent hydronephrosis, or a double collecting system had a significantly greater incidence of vesicoureteral reflux than children with normal RUS findings. Additionally, the occurrence of high-grade vesicoureteral reflux in children with abnormal RUS findings was more frequent than in children with normal RUS findings. The results of our study indicate that it is worth performing RUS in children with a first febrile urinary tract infection because abnormal kidney size or other specific structural ultrasound findings should be investigated, in addition to isolated hydronephrosis.

間欠性水腎症を呈した両側多発性尿管ポリープの1例

We report an unusual case of bilateral ureteral polyps causing intermittent hydronephrosis, which developed extensively in the upper part of ureters. The patient was an 8-year-old male. He had several episodes of gross hematuria with right flank pain. Ultrasonography of the kidney showed mild bilateral hydronephrosis, while this finding was markedly aggravated in association with the onset of pain. Intravenous pyelogram and retrograde pyelogram revealed multiple filling defects in both upper parts of ureters. Since the diseased part of the ureter was wide (about 7 cm in length), a segmental resection of the right ureter with mobilization of the right kidney was performed, followed by end-to-end ureteral anastomosis. The pathological diagnosis was fibroepithelial polyps. Regarding the disease of contralateral ureter, no surgical treatment was performed because he had no clinical symptoms. Six years after the surgery, he again developed gross hematuria with left flank pain. Marked dilatation of the left renal pelvis was shown by ultrasonography, which suggested left intermittent hydronephrosis caused by ureteral polyps. He underwent a partial ureterectomy with mobilization of the left kidney for the left ureteral disease. No recurrence of polyps has been observed in the urinary tract since this surgery.

Intermittent Hydronephrosis Secondary to Ureteropelvic Junction Obstruction: Clinical and Imaging Features

We sought to assess the clinical and imaging findings in intermittent hydronephrosis secondary to ureteropelvic junction obstruction, with particular emphasis on the characteristic ultrasonographic findings. This prospective, longitudinal, observational study included all children who had intermittent ureteropelvic junction obstruction and presented with abdominal pain over 6 years. Renal ultrasound was used as an initial screening tool to detect intermittent hydronephrosis. Renal ultrasonography was repeated every 1 to 2 days to record serial changes from the symptomatic to the asymptomatic stage. Their clinical manifestations and imaging findings were studied. Eighteen patients (14 boys, 4 girls) were studied. Most had sharp pain that began acutely and typically lasted for <2 days. Most of the children (16 of 18) had nausea and vomiting that accompanied the pain. The acute episode generally resolved spontaneously and was followed by a pain-free interval that ranged from days to months. Factors that predisposed to an attack included increased water intake, vigorous exercise, or bladder distention. All patients had clearly demonstrable obstruction of the renal pelvis during an acute attack, a finding that diminished or resolved during the symptom-free intervals. During convalescence, all patients had renal pelvic wall thickening on ultrasonography. This finding appeared on the second or third day after a painful episode subsided, persisted for 6 to 9 days, and then disappeared in the symptom-free stage. Pyeloplasty was performed in 17 patients, none of whom had recurrent pain on follow-up. Extrinsic obstructions were found in 9 patients. The keys to diagnosis are awareness of the syndrome, a detailed history, and immediate and serial imaging studies during painful crises. A thickened renal pelvic wall during convalescence is an important ultrasonic sign of intermittent hydronephrosis.

Benign Fibroepithelial Polyps Causing Symptomatic Bilateral Intermittent Hydroureteronephrosis

Intermittent symptomatic hydronephrosis secondary to ureteropelvic junction obstruction is common in children. Fibroepithelial polyps uncommonly cause intermittent hydroureteronephrosis. We report an unusual case of bilateral distal ureteral fibroepithelial polyps causing symptomatic hydroureteronephrosis.

First report of distal obstructive uropathy and prune-belly syndrome in an infant with amniotic band syndrome.

We describe the first report of distal obstructive uropathy and prune-belly syndrome in an infant with amniotic band syndrome. Prenatal ultrasonographic examination in the third trimester revealed intermittent oligohydramnios, bilateral hydronephrosis, and megacystis. Postnatally, the infant was found to have a scalp defect, a skin pedicle, pseudosyndactyly and constriction rings on the hands, marked distention of the abdomen, a fibrous band attached to the proximal urethra causing urethral stricture, a swollen penile shaft, bilateral talipes equinovarus, and syndactyly of the feet. Multiple fibrous amniotic bands could be identified in the placenta. Our case shows that fetal distal obstructive uropathy can be associated with the congenital constriction band syndrome.

Prenatal hydronephrosis caused by aberrant renal vessels: a follow-up challenge. Reports of two cases.

With routine use of obstetric ultrasonography, fetal low-grade hydronephrosis is commonly detected, but may resolve spontaneously after birth. Two cases are presented to illustrate that in some cases such findings can express intermittent hydronephrosis caused by aberrant renal vessels. Renal deterioration later in childhood may be a consequence.

Intermittent hydronephrosis. A clinical study in 23 pediatric patients

It is difficult to diagnose intermittent hydronephrosis and to decide the indication of surgical intervention. We investigated 23 cases of intermittent hydronephrosis. From 1978 to 1995, a total of 23 patients were diagnosed as intermittent hydronephrosis in our institution. We inspected their clinical features and treatment which had been performed to them. Our study comprised 21 boys and 2 girls, whose mean age was 6 year old. Their chief complaint was intermittent flank pain (left: 21, right: 1, bilateral: 1) accompanied with gross hematuria (30%) and vomiting (39%). When they were asymptomatic, an excretory urogram revealed only mild pelvic dilatation without calyceal distension and kinking of ureteropelvic junction. Split renal function study by RI showed no difference between the affected side and the normal side except one case. When pelvic or calyceal enlargement was confirmed on ultrasonography while they were symptomatic, surgery was indicated. Surgery was performed in 17 cases (74%) including dismembered pyeloplasty in 14 cases, resection of aberrant vessel in 1, relocation of lower pole renal vessel in 1 and nephrectomy in 1. In surgical and histological view points, intrinsic stenosis was seen in 10 cases, extrinsic obstruction caused by aberrant vessels was seen in 4 and ureteral polyp was seen in 3 (bilateral polyp in 1 case). They had no more symptoms after operation. Of 23 among followed up cases without surgery, we experienced 2 cases unexpectedly advancing irreversible hydronephrotic change after the last attack, 1 case of gradually progressing hydronephrotic change and 1 case of severe renal dysfunction after many attacks. Therefore intermittent hydronephrosis should be followed up carefully.

Intermittent hydronephrosis as a cause of a false-negative pressure-flow study

A case is reported of a negative pressure-flow study in a patient with intermittent hydronephrosis. This is the first known report of a properly performed pressure-flow study failing to diagnose obstruction due to the intermittent nature of the obstruction itself. This case also supports the concept that the ureteropelvic junction (UPJ) can be intrinsically normal in patients with intermittent hydronephrosis secondary to a crossing renal vessel. It also reaffirms the need to study these patients while they are symptomatic.

Intermittent Hydronephrosis: A Diagnostic Challenge

Intermittent hydronephrosis is a difficult condition to diagnose because of the mild degree of dilatation encountered in imaging studies. The condition nevertheless is disabling and attempts to reach a precise diagnosis include diuretic excretory urography, ultrasonography and renal scans. The delayed double-peak pattern seen on 99mtechnetium-diethylenetriaminepentaacetic acid diuretic renography shows how the ureteropelvic junction can become self-obstructing with forced diuresis. All patients who exhibited this sign eventually had frank obstruction and most exhibited an extrinsic component to the obstruction. The recognition of the double-peak pattern may become a useful adjunct in the early diagnosis of intermittent hydronephrosis.

Ureteropelvic Junction Obstruction. I. Observations on the Classic Type in Adults

A total of 111 adults underwent repair of congenital ureteropelvic junction obstruction during a 15-year period. A majority of the patients (77 per cent) presented with flank pain. In all patients established (89 per cent) or intermittent (11 per cent) hydronephrosis was demonstrated. In contrast with our former practice, a majority of the patients (86 per cent) underwent dismembered pyeloplasty with intubation. Of the 10 hypertensive patients 8 remained hypertensive postoperatively but only 3 of 22 patients with stones had recurrent calculi. The success rate was 95 per cent with 1 operation. Three patients required a second repair and 1 underwent nephrectomy. Therefore, the eventual success rate was 99 per cent.