Postnatal Management of Fetal Hydronephrosis

Abstract

To differentiate neonates with hydronephrosis who will benefit from early surgical treatment from those who will not.
Patients and Methods : Twelve consecutive neonates with a history of fetal hydronephrosis in 19 renal units were treated conservatively. Investigations included urinalysis, serum creatinine, ultrasonography, diuretic radionuclide renography and intravenous pyelography. Surgery was indicated when there was evidence of recurrent urinary tract infection and deteriorating differential renal function of the involved kidneys.
Results : Postnatal ultrasound confirmed hydronephrosis in 17 out of 19 renal units. Based on drainage curve obtained on diuretic radionuclide renography, patients were classified into obstructive (9 units), non-obstructive (5 units) and equivocal group (3 units). Diagnoses in the first group were uretero-pelvic junction obstruction in 8 and ectopic ureterocele in 1. Pyeloplasty was done in 7 renal units and heminephrectomy was performed for ectopic ureterocele. Average age at operation was 15 months. None of the non-obstructive group required surgery after an average of 24 months of follow up. There was one dropout in equivocal group. One neonate underwent ureteroneocystostomy for megaureter at 18 months of age, while the remaining neonate has been doing well on regular follow after 27 months.
Conclusion : Approximately half of neonates with history of fetal hydronephrosis ultimately required surgery. Diuretic radionuclide renography was useful in differentiating between neonates whose hydronephrosis ultimately required surgery and those with a benign outcome.