Outcome of antenatally diagnosed hydronephrosis- our series

1. Outcome of antenatally diagnosed hydronephrosis- our series VIJAYANAND, VENKATA SAI, RAMESH BABU S, SUNIL SHROFF,RAJAMANIKAM Paediatric Urology & Paediatric Nephrology Units Departments of Radiology & Urology SRI RAMACHANDRA MEDICAL COLLEGE AND RESEARCH INSTITUTE, CHENNAI

2. INTRODUCTION • Ultrasonogram has become a routine imaging modality to diagnose congenital anomalies. • Hydronephrosis is one of the common anomaly detected in the fetus • Incidence of antenatally detected hydronephrosis 2 – 4 % • Antenatal diagnosis of hydronephrosis causes a significant distress to the parents during pregnancy.

3. INTRODUCTION • Antenatal counseling is being done regularly these days. • It is important to know the natural history of the disease to give the parents an idea of what they can expect . • The existing literature on the outcome of antenatal hydronephrosis are unclear.

4. AIMS AND OBJECTIVES • To asses the outcome of antenatally diagnosed hydronephrosis in our series of patients. • To find out which children would require early surgical intervention, and who would require follow up evaluation. • To create a guideline for antenatal counseling based on our findings.

5. Materials and methods • The study was conducted for 5 years from 2003 to 2008. • All the patients who were seen in our hospital with antenatally diagnosed hydronephrosis were included in the study.

6. Materials and methods • The patients were followed up throughout the course of pregnancy and after birth. • Post natal evaluation included ultrasound (1-3 monthly) • Whenever indicated MCU, DTPA performed • Patients were followed from 1 to 4 years with a median follow up of 2.4 years.

7. Patient Groups • The patients were divided into two groups based on fetal USG, • Group I - Isolated unilateral hydronephrosis. • Group II – Hydroureter, bilateral involvement, bladder wall thickening. • The outcome between groups were compared.

8. Fetal hydronephrosis Unilateral, isolated (PUJ) Bilateral, HUN, Bladder abnormality USG at 24 Hrs USG at 72 Hrs AP diameter MCU <15mm 15-25mm 25-40mm >40mm Intervention (PUV, Ureterocele) USG / 3 monthly followup Monthly USG DTPA surgery Improves  Follow up

9. RESULTS • 2003- 2008 • Total number of patients registered - 140 • Defaulters for follow up - 24 • Total included patients - 116 • Group I (Isolated hydro) - 78 • Group II (HUN, bilatera) - 38

10. Fetal Ultrasound Unilateral hydronephrosis

11. Post Natal Ultrasound Post natal USG Post natal HUN

12. OUTCOME OF ANTENTAL HYDRONEPHROSIS • Group I- Isolated hydronephrosis (n= 78) • Required surgery 7 (9%) • Group II – HUN, Bilateral (n=38) • Required surgery 21 (55%) • Fisher’s exact test P = 0.002 (significant) Group I Group II

13. Group 1: Isolated Hydronephrosis (PUJ)7/78 required surgery Chi-square test P < 0.001

14. Outcome in group II21/38 required surgery

15. Conclusions • Group 1: Isolated fetal hydronephrosis • Vast majority are minimal hydronephrosis which resolve spontaneously • Only 9% require surgery • Group II: Ureterohydronephrosis, Bilateral etc • 55% required intervention • PUV, VUJ, Ureterocele etc

16. Conclusions The parents of fetuses with isolated fetal hydronephrosis could be favorably counselled.

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