Treatment of hydronephrosis due to narrowing of the ureteropelvic junction
Narrow pyelonephritis - ureteral junction is the most common cause of obstructive disease in children, most commonly around 5 years of age. The prevalence of hydronephrosis due to narrowing of the pyelonephritis - ureteral junction in men is twice that of women. Hydronephrosis on the left is more common than on the right, and hydronephrosis on both sides accounts for about 10%.
Tests: urea, complete blood count, urinalysis, creatinine,... Ultrasound: shows the size of the kidney, the thickness of the renal parenchyma and also helps to distinguish it from dilatation of the ureter, detecting polycystic kidney on the other side. X-ray: intravenous contrast urography, bladder contrast during urination, kidney scan with Tc99m. In addition, it is necessary to make a differential diagnosis for the following cases:
Hydronephrosis due to ureteral aneurysm: differentiate based on ultrasound Hydronephrosis due to vesico-ureteral reflux Double kidney Polycystic kidney Case of dumb kidney on X-ray- X-ray: Ultrasound will help confirm this is a hydronephrosis due to narrowing of the junction or due to dilatation of the ureter. If polycystic kidney, ultrasonography confirmed no damage to the renal pelvis and calyces.
3. Treatment of hydronephrosis
3.1 Conservative treatment Indications for conservative treatment: when surgery is not indicated. Conservative treatment:
Monitor the size of the kidney - pyelonephritis on ultrasound every 3 - 6 months. If the kidney is enlarged, reassess renal function on renal scintigraphy. Antibiotics for UTIs. Prophylactic antibiotics: severe bilateral hydronephrosis, hydronephrosis detected before birth with RPD > 15mm. Drug of choice: amoxicillin 12-25mg/kg/day orally. The duration of drug use starts immediately after birth until the combined urinary system abnormalities such as vesicoureteral reflux, posterior urethral valve are excluded. 3.2 Surgical treatment 3.2.1 Indications Surgery is indicated when:
There are symptoms: abdominal pain, infection, kidney stones, palpable large kidney. Asymptomatic but with reduced renal function less than 40% on renal scan. Failure of conservative treatment: increased renal size on ultrasound and renal function less than 40% or decreased renal function more than 10% on scan compared with previous. Giant hydronephrosis with anteroposterior renal pelvis diameter – RPD > 50mm on ultrasound. 3.2.2 Surgical methods The surgical steps include:
Shaping the pyelonephritis - ureter according to Anderson - Hynes through laparoscopic, open surgery or robotic surgery. Urinary catheterization with a JJ catheter or a ureteral stent or a percutaneous nephrostomy catheter. When renal function is less than 10% on scintigraphy: radical surgery or pyelonephritis. Renal drainage: After 1-2 months of drainage, renal function will be re-evaluated. If kidney function improves, pyeloplasty is performed. Nephrectomy for the following cases: Complete loss of kidney function. After pyelonephritis, renal function did not improve. Small atrophic hydronephrosis with loss of function or recurrent urinary tract infections. After surgery, patients need to be treated with antibiotics, and pain relief after surgery. Place a ureteral stent and remove it 5-7 days after surgery. For JJ catheterized patients, withdraw the JJ through cystoscopy after 1-2 months.
4. Common Complications
Bleeding Infection Anastomal fistula Obstruction anastomosis Complications related to JJ Catheter Obstruction Recurrent anastomosis Therefore, after surgery Patients should be closely monitored, with ultrasound 1 month after surgery and every 3-6 months for at least 2 years to assess the improvement of fluid retention and symptoms. If 3-6 months after surgery, the degree of fluid retention does not change or worsens or renal scintigraphy is indicated to re-evaluate the surgical results,
In summary, hydronephrosis due to stricture of the ureteropelvic junction is an internal or external narrowing of the junction between the renal pelvis and the ureter. Treatment of hydronephrosis due to narrowing of the ureteropelvic junction can be treated conservatively or surgically when indicated. After surgery, the patient may experience a number of complications, so when there are any abnormal signs, it is necessary to immediately notify the medical staff, periodically visit for timely treatment.
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