A Study on Clinical profile and Outcome of Renal Duplication in Children

Jeevarathy, T (2013) A Study on Clinical profile and Outcome of Renal Duplication in Children. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Renal duplication is the commonest and most significant anomaly in pediatric urology. Incidence in the general population is 0.8 %. Wide variety of clinical manifestations will occur due to reflux, obstruction by ureterocele and ectopic ureteric orifice. Appropriate management needs assessment of the anatomy of the renal system, understanding the source of morbidity and demonstrating functional renal moiety. Commonly upper pole of the duplex system is associated with ureteral ectopia and ureterocele. Lower pole of the duplex system is associated with vesico-ureteric reflux and Pelvi-ureteric junction obstruction. Surgical options include primary bladder surgery and primary upper urinarytract surgery. Primary bladder surgery includes transurethral incision of ureterocele, common sheath Ureteric reimplantation. Upper tract surgery includes heminephrectomy for non functioning moiety, uretero-ureterostomy and ureteropyelostomy for the affected moiety with adequate function. The purpose of this study is to find out the various manifestations of the renal duplication, its surgical management and its outcome. AIMS AND OBJECTIVES: The primary aim is to study the Incidence, types of Renal Duplication and the outcome of surgical management individualized for each patient. The secondary objectives are to analyse the value of imaging (USG, Excretory urography, Nuclear scan) in the management of Renal Duplications. MATERIALS AND METHODS: STUDY POPULATION: All patients with double moiety kidney based on antenatal scan, clinical symptoms, and proved by investigations were included. NATUREOF STUDY: Prospective study/ descriptive study. NO. OF CASES: 40 STUDY PERIOD: September 2010 to January 2013, INCLUSION CRITERIA: All children with image documented double moiety, treated as inpatient in department of Pediatrics surgery at ICH, Egmore were included. EXCLUSION CRITERIA: Renal duplication associated with lower urinary tract duplication, Single moiety ureterocele, Horse shoe kidney with double moiety were excluded. METHODOLOGY: All antenatally diagnosed hydrnephrosis cases, children who presented with urinary symptoms like pyuria, difficulty in micturition, febrile UTI and urinary dribbling were admitted. The patients were subjected to detailed clinical examination and relevant investigatons were performed,namely,ultrasound examination, MCU, IVU, Scopy, renogram. Proven cases with double moiety were included in the study. RESULTS: The study comprised of 40 patients who were admitted and evaluated for Renal Duplication from September 2010 to January 2013. These 40 patients satisfied the inclusion and exclusion criteria. In our study, Renal duplication was present commonly in infants with 23 (57.5%) out of 40 patients presenting less than 1 year. In this study renal duplication was more frequent in female children (22 patients) than in males (18 patients) in the ratio of 1.2:1. 15 patients (37.5%) were diagnosed on prenatal ultrasound screening. Out of the 15 cases, 11 were diagnosed as hydronephrosis, 2 were identified as double moiety and 2 were reported as ureterocele. On following up these 15 patients, 13 were operated. The most common surgery performed being upper moiety heminephrectomy. The most common clinical presentation in symptomatic patients were fever with urinary tract infection. Unilateral presentations were more common with right sided predominance. Ultrasound Abdomen was very sensitive in diagnosing duplex system with a sensitivity of 87%. Ultrasound was able to recognise hydronephrosis of the duplex system precisely in most of the cases. VCUG demonstrated reflux in 35% (14 pts) of patients and ureterocele in 15%. IVU was used to assess the functioning status of the moieties and the presence of ureterocele. It also demonstrated the status of opposite kidney. Diuretic Renogram was done in only 40% of patients to document the function of affected moiety. The incidence of non-functioning moiety (<10% function) was found to be 62%. MRU was performed selectively to delineate the anatomy in the most complex of cases. A diagnostic cystoscopy was done in 95% of patients in our study. Cystoscopy was more sensitive in diagnosing ureterocele. The most common surgery advocated was upper moiety heminephrectomy in 35 % of patients. Endoscopic Deroofing of ureterocele was done in 27.5%. CONCLUSION: Renal duplications are one of the common congenital anomalies affecting children • Renal duplications are slightly more common in female children. • Renal duplications are mostly asymptomatic, nowadays frequently identified in prenatal screening ultrasound. • Symptomatic patients more commonly present in infancy. • Ultrasound is very sensitive screening investigation in diagnosing duplex anomalies • Intravenous urogram is an excellent tool in delineating the anatomy of functioning moiety. • Magnetic resonance urogram is very sensitive in delineating the anatomy of the non-functioning moiety and identifying ectopic ureter. • Diuretic renogram is helpful in assessing the functional status of the moieties and planning the treatment. • Cystoscopy is very sensitive in diagnosing ureterocele and deroofing is the most common initial surgery for ureterocele. • Upper moiety heminephrectomy is the most commonly performed surgery for symptomatic non-functioning duplex anomalies.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Renal Duplication in Children, Clinical profile, Outcome.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Subramani R
Date Deposited: 16 Feb 2020 02:21
Last Modified: 16 Feb 2020 02:21
URI: http://repository-tnmgrmu.ac.in/id/eprint/11951

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