A Study proposal on Antenatal diagnosed hydronephrosis due to ureteropelvic junction obstruction - A 3 year study.

Rahrajaa, S R (2011) A Study proposal on Antenatal diagnosed hydronephrosis due to ureteropelvic junction obstruction - A 3 year study. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Congenital hydronephrosis caused by ureteropelvic junction obstruction has challenged the ingenuity of paediatric surgeons and remains one of the most enigmatic clinical problems today. Ureteropelvic Junction obstruction may be defined as a functional or anatomic obstruction to urine flow from the renal pelvis to the ureter that left untreated results in symptoms or renal damage. Currently, most instances of ureteropelvic junction obstruction are diagnosed in the perinatal period as a result of widespread use of antenatal ultra sonogram. Now a days the presentation, diagnostic and therapeutic modalities also have been changed. Although both surgical and nonsurgical measures have proved generally therapeutic, search for the perfect cure for this common problem continues. AIM AND OBJECTIVES : 1. Post natal evaluation of Antenatal diagnosed hydronephrosis due to UPJ obstruction. 2. Analysis of clinical and imaging parameters employed to decide future management. 3. Analysis of surgical aspects and outcomes of Antenatal detected hydronephrosis due to Uretro Pelvic Junction obstruction. SELECTION CRITERIA : 1. Inclusion criteria-Antenatal diagnosed hydronephrosis with post natal ultrasound showing unilateral Ureteropelvic Junction obstruction. 2. Exclusion criteria-All patients of Antenatal diagnosed hydronephrosis during post natal ultrasound evaluation showing ureteral dilatation/bladder involvement (Bilateral UPJ, uretercoele, vesicoureteral reflux etc) were excluded from the study. METHODS : This is a prospective study conducted in the department of Paediatric surgery, Institute of Child Health and Hospital over a period of 30 months (1/08/2008 to 31/1/2011). The patients who fit into the above selection criteria were treated at the departments of Paediatric surgery and Paediatric urology. Antenatal diagnosed hydronephrosis were critically analysed in postnatal period based on the following parameters: 1. Clinical examination. 2. Biochemical investigation (urea, creatinine and electrolytes). 3. Post natal ultrasound (Neonates) done on D3 of life or beyond at time of presentation and repeat ultrasound 1month. 4. Ivu/DTPA scan done at age of 1 month/ beyond at time of presentation. CONCLUSION : In this study, the sex distribution is found as male and female (1.9:1) with male preponderance. The side distribution is with slight predominance of left side over right side as 60% / 40%. In this study most common symptom at presentation is asymptomatic with antenatal scan (76%) and palpable mass (20%), UTI 2%. On serial follow-up of 50 cases, in which 40 cases (80%) progress to surgical intervention. All cases with clinically palpable mass in early infants were subjected to surgery. Ultra sound on serial measurements showed Trans pelvic diameter > 2.5 cm progressed to surgery, if TPD < 2.5 cm improved without surgery on follow-up. The renal function as assessed by post operative DTPA scan, showed the significant improvement of renal function in infants group who underwent early pyeloplasty. Post-operative intravenous urogram showed a good correlation with post-operative DTPA if there is complete drainage of contrast at 4hours film. Indications for surgery were based on following parameters : (a) Transverse Pelvic Diameter >2.5 cm (b) DTPA <40% (c) Obstructive pattern in drainage curve.

Item Type: Thesis (Masters)
Uncontrolled Keywords: antenatal diagnosed ; hydronephrosis ; ureteropelvic junction ; obstruction ; Three year study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 03:02
Last Modified: 28 Jul 2017 03:02
URI: http://repository-tnmgrmu.ac.in/id/eprint/2294

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