Severe Bilateral Hydronephrosis Research Articles

Severe Hydronephrosis Caused by Uterine Prolapse withNon Specific Symptoms and Normal Renal Function

www.SID.ir Int J Women’s Health Reproduction Sci Vol. 1, No. 3, Autumn 2013 ISSN 2330-4456 Severe Hydronephrosis Caused by Uterine Prolapse with Non Specific Symptoms and Normal Renal Function Muammer Altok1*, Ali Feyzullah Sahin2, Mehmet Umul1, Mustafa Gunes1 Abstract : Pelvic organ prolapse (POP), is the descent of pelvic organs (bladder, uterus, rectum) until protrusion through the vagina and related to the loss of normal attachment and support of the pelvic floor. Pelvic organ prolapse (POP) is a common problem in elderly women and usually causes various urologic symptoms. One of the most important complications of POP is hydronephrosis. The hydronephrosis is usually mild. Severe hydronephrosis is very rare. Hydronephrosis caused by POP may lead to renal dysfunction and serious urinary infections. Early detection and treatment is very important for preventing irreversible renal damage. Hereby, we report a case of 65-years-old woman who had massive uterine prolapse with silent severe bilateral hydronephrosis. She had no complaint except a protruding tissue out of her vagina. Renal function was normal and hydronephrosis was detected incidentally. The symptoms may be non-specific and silent until a serious infection or renal dysfunction. Therefore patients with a POP especially with severe POP need to have evaluation and imaging about the condition or the urinary system before a serious pathology occur.

Clinical, ultrasonographic and pathological description of bladder distension with consequent hydroureters, severe hydronephrosis and perirenal fluid accumulation in two rams putatively ascribed to pelvic nerve dysfunction

Marked urinary bladder distension, hydroureters, severe bilateral hydronephrosis, and perirenal fluid accumulation were identified ultrasonographically in two rams from the same farm but separated by 24 months’ interval. Both rams were observed to urinate but the flow rate of urine was estimated to be less than normal and the duration was reduced to around 5–10s when around 20–30s is considered normal. There was normal tail and rectal muscle tone, and normal perineal and pelvic limb reflexes. A presumptive diagnosis of pelvic nerve dysfunction causing detrusor atony and bladder distension with secondary pressure-induced hydronephrosis is suggested but unproven. Detailed dissection at necrospy found no evidence of urethral obstruction.

Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

Management of a hypoplastic lower urinary tract: a case report

This case relates to a child with an antenatal diagnosis of severe bilateral hydronephrosis with congenital anomalies of the ureters, bladder, and urethra. We describe the presentation and surgical management, highlighting the complexity of this anomaly and the surgical technique used to reconstruct the lower urinary tract. To our knowledge, there has not been a similar case in the literature and the use of a segment of colon for ureteric substitution in children has not been previously reported in the literature.

Bilateral ureteropelvic junction obstruction presenting with hypertension and cerebral vascular accident

Cerebrovascular accident and renal hypertension secondary to ureteropelvic junction obstruction (UPJO) are extremely rare. A 6-year-old girl presented with intracranial hemorrhage because of hypertension secondary to the bilateral UPJO. This was successfully treated with craniotomy and subsequent percutaneous nephrostomy placement and bilateral pyeloplasty. Brain computerized tomography revealed right-sided intracranial hemorrhage, and renal ultrasonography confirmed bilateral severe hydronephrosis. Craniotomy with evacuation of intracerebral hematoma and bilateral nephrostomy under ultrasound guidance were performed. One week later, she underwent bilateral pyeloplasty in 2 stages. The patient has been well with normalized renal function and is completely cured of her hypertension in long-term follow-up.

Severe Bilateral Hydronephrosis and Hydroureter Secondary to Bladder Tuberculosis

Severe Bilateral Hydronephrosis and Hydroureter Secondary to Bladder Tuberculosis

AtypicalPlasmodium vivaxMalaria in a Traveler: Bilateral Hydronephrosis, Severe Thrombocytopenia, and Hypotension

We report a case of Plasmodium vivax infection manifested as severe thrombocytopenia, bilateral hydronephrosis, and hypotension in a returning traveler from a malaria-endemic area in Venezuela. While most of the efforts to prevent malaria in travelers focus on the life-threatening consequences of Plasmodium falciparum malaria, nonimmune travelers who encounter infection with P vivax may also develop serious complications. This case highlights the importance of preventing malaria cases among nonimmune or semi-immune individuals traveling to P vivax-endemic areas.

Massive fetal hemorrhage and fetomaternal alloimmune thrombocytopenia from human platelet antigen 5b incompatibility: an unusual association

Massive fetal hemorrhage and fetomaternal alloimmune thrombocytopenia from human platelet antigen 5b incompatibility: an unusual association

Congenital Nephrogenic Diabetes Insipidus Presented with Bilateral Hydronephrosis: Genetic Analysis of V2R Gene Mutations

Most cases of hydronephrosis are caused by urinary tract obstruction. However, excessive polyuric syndrome rarely gives rise to non-obstructive hydronephrosis, megaureter, and a distended bladder. The authors report here on two cases of congenital nephrogenic diabetes insipidus (NDI) with severe bilateral hydronephrosis and megaureter. It is Interesting that the patients were symptomless except for their polyuria, and they both presented with bilateral hydronephrosis. Fluid deprivation testing revealed the presence of AVP resistant NDI. Gene analysis for these patients showed the AVP receptor 2 (V2R) missense mutations (Q225X and S126F), which have previously been reported on in other studies. We made the diagnosis of NDI by using a physiologic test, and we confirmed it by mutation analysis of the V2R gene.

Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively.

We determine the outcome of severe bilateral primary ureteropelvic junction type hydronephrosis detected prenatally and managed postnatally with an initially nonoperative protocol. A total of 19 newborns (38 kidneys) with prenatally diagnosed primary grade 3 to 4 bilateral hydronephrosis were followed nonoperatively for a mean of 54 months (range 14 to 187). If urinary obstruction with evidence of renal deterioration (decreased differential function and/or progressive hydronephrosis) occurred pyeloplasty was performed. Pyeloplasty was required in 13 kidneys (35%) in 9 patients (bilateral 4, unilateral 5). Age at pyeloplasty ranged from 2 to 22 months (mean 6.5) in 12 patients and 64 months in 1. The remaining 25 kidneys were followed nonoperatively (bilateral 20, unilateral 5). At last followup the Society for Fetal Urology grade of hydronephrosis in kidneys followed nonoperatively was 0 to 2 in 21 and 3 in 4, compared to 0 to 2 in 9 and Society for Fetal Urology 3 in 4 kidneys treated with pyeloplasty. Mean followup required for the most severely hydronephrotic kidney to achieve maximum ultrasound improvement was 10 months (range 3 to 34) for kidneys followed nonoperatively and 14 months (4-31) for kidneys after pyeloplasty. Differential renal function was measured in each kidney pair and compared using the difference in percent function between the 2 kidneys. In the nonoperative group mean initial difference in percent function was 8% (range 6% to 20%) and mean final difference was 5% (2% to 8%). In the pyeloplasty group mean initial difference in percent function was 16% (range 8% to 30%) and mean final difference was 7% (2% to 16%). With close followup and prompt pyeloplasty renal function improved to greater than pre-deterioration levels in all kidneys. These data represent the natural history of severe bilateral newborn hydronephrosis. Renal dilatation and function improve with time in most kidneys. Close followup is required in the first 2 years of life to identify the subgroup (35%) of children with obstruction that requires prompt surgery. Such an approach prevented permanent loss of renal function. Nonoperative management with close followup during the first 2 years appears to be a safe and recommended approach for neonates with primary bilateral ureteropelvic junction type hydronephrosis.

A case of partial trisomy 4p syndrome presenting as severe hydronephrosis in utero

We describe the phenotypic features in a newborn infant with an unbalanced translocation 46,XY, der(22) inv(4) (p14p16.1) t(4;22) (p15.1;q13.31)pat. The phenotype was consistent with partial trisomy 4p syndrome. Severe bilateral hydronephrosis was diagnosed at a 31 week prenatal ultrasound scan. Both the patient phenotype and the partial trisomy are unusual, the latter due to the complex nature of the chromosomal rearrangement.Clin Dysmorphol12:179-181 © 2003 Lippincott Williams & Wilkins.

A case of partial trisomy 4p syndrome presenting as severe hydronephrosis in utero

We describe the phenotypic features in a newborn infant with an unbalanced translocation 46,XY, der(22) inv(4) (p14p16.1) t(4;22) (p15.1;q13.31)pat. The phenotype was consistent with partial trisomy 4p syndrome. Severe bilateral hydronephrosis was diagnosed at a 31 week prenatal ultrasound scan. Both the patient phenotype and the partial trisomy are unusual, the latter due to the complex nature of the chromosomal rearrangement.

Ultrasound-guided laser treatment for fetal bladder outlet obstruction resulting from ureterocele

In a case of severe bilateral hydronephrosis in a female fetus associated with ureterocele at 28 weeks, under local anesthetic, ultrasound-guided neodymium:yttrium-aluminum-garnet laser was used to perforate the ureterocele and successfully overcome the obstruction. There was no recurrence of obstruction, and renal function was normal postnatally. (Am J Obstet Gynecol 2003;188:1107-8.)

Assessment and Management of Fetal Hydronephrosis

After completing this article, the reader should be able to: 1. Differentiate genitourinary abnormalities associated with hydronephrosis detected on fetal ultrasonography. 2. Describe the type of fetal hydronephrosis that requires a complete uroradiologic evaluation. 3. Characterize the complete postnatal uroradiologic evaluation of significant fetal hydronephrosis. 4. Delineate the factor that sets the timetable for postnatal uroradiologic evaluation. 5. Describe the neonates for whom diuretic renography is reserved. Ultrasonographic detection of antenatal anomalies in the fetus has increased steadily since its initial widespread use in the 1970s. During these early years, antenatal ultrasonography detected structural abnormalities in approximately 1% to 3% of all pregnancies. (1) Currently, it is estimated that genitourinary anomalies comprise 20% of all antenatally detected fetal anomalies. (2) In a recent British population-based study, fetal genitourinary anomalies were identified in 2.3% of women undergoing routine obstetric ultrasonography between 18 and 23 weeks of gestation. (3) Hydronephrosis clearly has become the most commonly detected antenatal anomaly on fetal ultrasonography. Detection of antenatal dilation of the urinary tract does not always indicate postnatal urinary tract obstruction or even a significant genitourinary anomaly. (4) Among infants diagnosed as having prenatal hydronephrosis or other genitourinary anomalies, the question often is raised about the need for and extent of the postnatal evaluation to assess the magnitude of this commonly detected antenatal anomaly. The purpose of this review is to provide a framework for assessment and management of antenatally detected hydronephrosis. Fetal hydronephrosis is a nonspecific finding that can be associated with multiple congenital anomalies of the genitourinary tract. A thorough understanding of disorders that can result in hydronephrosis postnatally allows the physician to assess the need for postnatal diagnostic tests and guide treatment recommendations. The congenital anomalies that may result in hydronephrosis can be categorized as disorders of urinary reflux and disorders of urinary obstruction. It can be …

Severe megacystis and bilateral hydronephrosis in a female fetus

The differential diagnosis for antenatal bladder dilation and hydronephrosis is extensive, ranging from posterior urethral valves to neurogenic bladder. We present a case of a female fetus diagnosed antenatally with severe megacystis and bilateral hydroureteronephrosis. The patient was found to have megacystis-microcolon-intestinal hypoperistalsis syndrome, a rare, congenital, and generally fatal disorder in which there is functional obstruction of the bladder and intestine.

Long-term Followup of Prenatally Detected Severe Bilateral Newborn Hydronephrosis Initially Managed Nonoperatively

We determine the outcome of severe bilateral primary ureteropelvic junction type hydronephrosis detected prenatally and managed postnatally with an initially nonoperative protocol. A total of 19 newborns (38 kidneys) with prenatally diagnosed primary grade 3 to 4 bilateral hydronephrosis were followed nonoperatively for a mean of 54 months (range 14 to 187). If urinary obstruction with evidence of renal deterioration (decreased differential function and/or progressive hydronephrosis) occurred pyeloplasty was performed. Pyeloplasty was required in 13 kidneys (35%) in 9 patients (bilateral 4, unilateral 5). Age at pyeloplasty ranged from 2 to 22 months (mean 6.5) in 12 patients and 64 months in 1. The remaining 25 kidneys were followed nonoperatively (bilateral 20, unilateral 5). At last followup the Society for Fetal Urology grade of hydronephrosis in kidneys followed nonoperatively was 0 to 2 in 21 and 3 in 4, compared to 0 to 2 in 9 and Society for Fetal Urology 3 in 4 kidneys treated with pyeloplasty. Mean followup required for the most severely hydronephrotic kidney to achieve maximum ultrasound improvement was 10 months (range 3 to 34) for kidneys followed nonoperatively and 14 months (4-31) for kidneys after pyeloplasty. Differential renal function was measured in each kidney pair and compared using the difference in percent function between the 2 kidneys. In the nonoperative group mean initial difference in percent function was 8% (range 6% to 20%) and mean final difference was 5% (2% to 8%). In the pyeloplasty group mean initial difference in percent function was 16% (range 8% to 30%) and mean final difference was 7% (2% to 16%). With close followup and prompt pyeloplasty renal function improved to greater than pre-deterioration levels in all kidneys. These data represent the natural history of severe bilateral newborn hydronephrosis. Renal dilatation and function improve with time in most kidneys. Close followup is required in the first 2 years of life to identify the subgroup (35%) of children with obstruction that requires prompt surgery. Such an approach prevented permanent loss of renal function. Nonoperative management with close followup during the first 2 years appears to be a safe and recommended approach for neonates with primary bilateral ureteropelvic junction type hydronephrosis.

Editorial: the Long-term Followup of Prenatally Detected Severe Bilateral Newborn Hydronephrosis Initially Managed Nonoperatively

Editorial: the Long-term Followup of Prenatally Detected Severe Bilateral Newborn Hydronephrosis Initially Managed Nonoperatively

Long-term Followup of Prenatally Detected Severe Bilateral Newborn Hydronephrosis Initially Managed Nonoperatively

Long-term Followup of Prenatally Detected Severe Bilateral Newborn Hydronephrosis Initially Managed Nonoperatively

NONOPERATIVE MANAGEMENT OF NEONATAL MODERATE TO SEVERE BILATERAL HYDRONEPHROSIS

The natural history of prenatally diagnosed bilateral ureteropelvic junction hydronephrosis is unknown. No definite recommendations exist regarding management, and many authors recommend unilateral or bilateral pyeloplasty. We present the results of nonoperative management of bilateral hydronephrosis. A total of 16 patients (32 kidneys) with prenatally diagnosed moderate to severe bilateral hydronephrosis were followed nonoperatively. Pyeloplasty was performed only for evidence of deterioration of function and only unilateral surgery was performed when necessary. Of the 32 kidneys 31 had moderate or severe hydronephrosis and 4 (12.5%) required pyeloplasty during a mean followup of 36 months. Hydronephrosis spontaneously resolved or improved in 78% of those observed nonoperatively. Of the 25 kidneys followed nonoperatively for at least 2 years 80% demonstrated improvement. While initial drainage half-time was more than 20 minutes in 55% of kidneys, 78% of unoperated kidneys had a final half-time of less than 20 minutes. Of the 10 kidneys with bilateral severe hydronephrosis 3 (30%) required pyeloplasty. All children had normal glomerular filtration rate for age at the latest followup. Only 1 child has persistent bilateral severe hydronephrosis at age 1 year. Initial nonoperative observation appears to be safe in all cases of moderate to severe bilateral neonatal hydronephrosis. Spontaneous improvement can be expected in most kidneys by 2 years. Only a few children require unilateral pyeloplasty and bilateral operation can be avoided in most cases.

Nonoperative management of neonatal moderate to severe bilateral hydronephrosis.

The natural history of prenatally diagnosed bilateral ureteropelvic junction hydronephrosis is unknown. No definite recommendations exist regarding management, and many authors recommend unilateral or bilateral pyeloplasty. We present the results of nonoperative management of bilateral hydronephrosis. A total of 16 patients (32 kidneys) with prenatally diagnosed moderate to severe bilateral hydronephrosis were followed nonoperatively. Pyeloplasty was performed only for evidence of deterioration of function and only unilateral surgery was performed when necessary. Of the 32 kidneys 31 had moderate or severe hydronephrosis and 4 (12.5%) required pyeloplasty during a mean followup of 36 months. Hydronephrosis spontaneously resolved or improved in 78% of those observed nonoperatively. Of the 25 kidneys followed nonoperatively for at least 2 years 80% demonstrated improvement. While initial drainage half-time was more than 20 minutes in 55% of kidneys, 78% of unoperated kidneys had a final half-time of less than 20 minutes. Of the 10 kidneys with bilateral severe hydronephrosis 3 (30%) required pyeloplasty. All children had normal glomerular filtration rate for age at the latest followup. Only 1 child has persistent bilateral severe hydronephrosis at age 1 year. Initial nonoperative observation appears to be safe in all cases of moderate to severe bilateral neonatal hydronephrosis. Spontaneous improvement can be expected in most kidneys by 2 years. Only a few children require unilateral pyeloplasty and bilateral operation can be avoided in most cases.