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Advances in Clinical and Experimental... Aug 2017Ureteropelvic junction obstruction (UPJO) causes a reduction in the urine flow from the renal pelvis into the ureter. Untreated UPJO may cause hydronephrosis, chronic... (Review)
Review
Ureteropelvic junction obstruction (UPJO) causes a reduction in the urine flow from the renal pelvis into the ureter. Untreated UPJO may cause hydronephrosis, chronic infection or urolithiasis and will often result in progressive deterioration of renal function. Most cases of UPJO are congenital; however, the disease can be clinically silent until adulthood. Other causes, both intrinsic and extrinsic, are acquired and include urolithiasis, post-operative/inflammatory/ischemic stricture, fibroepithelial polyps, adhesions and malignancy. In the past, the most frequent symptom of UPJO in neonates and infants was a palpable flank mass. Nowadays, thanks to the widespread use of maternal and prenatal ultrasound examinations, asymptomatic hydronephrosis is diagnosed very early. In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria. In addition to high specificity and sensitivity in detecting UPJO, modern technologically advanced equipment such as ultrasound, magnetic resonance imaging and computed tomography provides a lot of information about the function of the affected kidney and the anatomy of the surrounding tissues. Treatment options for UPJO include a wide spectrum of approaches, from active surveillance or minimally invasive endourologic techniques to open, laparoscopic or robotic pyeloplasty. The main goal of therapy is to relieve symptoms and maintain or improve renal function, but it is difficult to define treatment success after UPJO therapy.
Topics: Humans; Hydronephrosis; Kidney Pelvis; Prognosis; Risk Factors; Ureteral Obstruction; Urinary Bladder; Urodynamics
PubMed: 29068584
DOI: 10.17219/acem/59509 -
Annals of the Royal College of Surgeons... Sep 1977It is essential to distinguish between an obstructed and an unobstructed hydronephrosis as the management of the two types is quite different. Some of the radiographic...
It is essential to distinguish between an obstructed and an unobstructed hydronephrosis as the management of the two types is quite different. Some of the radiographic and isotopic methods of distinguishing these two leave much to be desired and the place of dynamic studies is discussed. The aetiology of pelviureteric junction obstruction remains uncertain, but it is probable that one or more of several factors may be involved and these are discussed. The types of hydroenphrosis are classified as chronic, intermittent, unsuspected, equivocal, and reflux-induced.
Topics: Adolescent; Adult; Chronic Disease; Female; Humans; Hydronephrosis; Male; Ureteral Obstruction; Urography
PubMed: 900795
DOI: No ID Found -
Pediatric Nephrology (Berlin, Germany) Apr 2018Over recent years routine ultrasound scanning has identified increasing numbers of neonates as having hydronephrosis and pelvi-ureteric junction obstruction (PUJO). This... (Review)
Review
Over recent years routine ultrasound scanning has identified increasing numbers of neonates as having hydronephrosis and pelvi-ureteric junction obstruction (PUJO). This patient group presents a diagnostic and management challenge for paediatric nephrologists and urologists. In this review we consider the known molecular mechanisms underpinning PUJO and review the potential of utilising this information to develop novel therapeutics and diagnostic biomarkers to improve the care of children with this disorder.
Topics: Animals; Biomarkers; Genetic Predisposition to Disease; Humans; Hydronephrosis; Kidney Pelvis; Molecular Biology; Molecular Targeted Therapy; Multicystic Dysplastic Kidney; Mutation; Ureter; Ureteral Obstruction
PubMed: 28286898
DOI: 10.1007/s00467-017-3629-0 -
Journal of Pediatric Urology Feb 2023Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed for conducting this systematic review and meta-analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis.
RESULTS
A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The incidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective effect against UTI with pooled OR of 0.28 (95% CI 0.23-0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17-0.32), obstructive hydronephrosis (pooled OR of 0.34; 95% CI 0.21-0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16-0.52).
CONCLUSION
Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irrespective of the underlying cause of hydronephrosis.
Topics: Male; Humans; Child; Female; Pregnancy; Circumcision, Male; Hydronephrosis; Risk Factors; Incidence; Urinary Tract Infections
PubMed: 36371332
DOI: 10.1016/j.jpurol.2022.10.029 -
TheScientificWorldJournal Jul 2009The majority of pregnant women in the U.S. undergo prenatal ultrasonography and approximately 0.5% of these examinations will detect fetal malformations. Up to one-half... (Review)
Review
The majority of pregnant women in the U.S. undergo prenatal ultrasonography and approximately 0.5% of these examinations will detect fetal malformations. Up to one-half of these abnormalities include the genitourinary system and the most common urological finding is hydronephrosis. Some conditions associated with prenatal hydronephrosis portend a poor prognosis, while others can follow a fairly benign course. This review focuses on the definition and prenatal assessment of hydronephrosis, fetal intervention, and postnatal management.
Topics: Female; Fetal Diseases; Humans; Hydronephrosis; Infant, Newborn; Kidney; Pregnancy; Ultrasonography, Prenatal
PubMed: 19618087
DOI: 10.1100/tsw.2009.85 -
Journal of Pediatric Urology Feb 2021There is still a lack of knowledge regarding the natural course of resolution of hydronephrosis after pyeloplasty, and no consensus exists on how resolution of...
BACKGROUND
There is still a lack of knowledge regarding the natural course of resolution of hydronephrosis after pyeloplasty, and no consensus exists on how resolution of hydronephrosis is defined or when resolution is expected to occur.
OBJECTIVE
To determine when resolution of hydronephrosis occurs following pyeloplasty, by type of obstruction and by surgical approach.
METHODS
This retrospective study included 125 children age <15 years treated with pyeloplasty and followed for two years with repeated ultrasound and MAG3 scan. Children with single kidneys, bilateral disease, and without hydronephrosis were excluded. Children with re-interventions were excluded in the evaluation of hydronephrosis but not in terms of success rate. Outcomes time to resolution of hydronephrosis (Anterior-Posterior diameter (APD) <10 mm or >50% reduction of APD) and 2-year success rate. Exposure was surgical approach and type of obstruction (intrinsic/extrinsic). Survival analysis was performed, adjusting for age, gender, year, laterality, preoperative renal function on MAG3, calyces dilatation and APD in the multivariable analysis.
RESULTS
At 12 months and 24 months follow-up, 90% and 93% had reached resolution, respectively. All children with persistent dilatation had improved drainage and stable or improved function on MAG3. There was no difference in time to resolution of hydronephrosis between open versus robotic-assisted laparoscopic surgery (adjusted HR 0.90, [0.54-1.52], p = 0.70), nor between different types of obstruction (aHR 0.84 [0.53-1.34], p = 0.47). Eight children had re-intervention, all identified within 3 months after primary surgery, and four had a postoperative drop on MAG3, giving a total success rate of 91% (121/135).
DISCUSSION
The vast majority of cases resolve and do so within 12 months from surgery. Since the improvement of hydronephrosis seems small between the first and second year after surgery, the value of follow-up beyond 12 months could be questioned. Based on the present study and previous literature we would recommend that children with persisting dilatation should continue their follow-up with ultrasound beyond 12 months. Children with complete resolution of their hydronephrosis at 12 months do not likely benefit from further follow-up. The same follow-up protocol should be applied, regardless of whether the obstruction is intrinsic or extrinsic in nature, or the surgery is performed with open or robotic-assisted approach. Overall, the definition of resolution of hydronephrosis varies in the literature and have impact on the results and may compromise comparisons.
CONCLUSION
Surgical approach or type of obstruction does not seem to affect time to resolution of hydronephrosis after pyeloplasty in children. Follow-up with ultrasound beyond 12 months does not seem to benefit children with complete resolution.
Topics: Adolescent; Child; Follow-Up Studies; Humans; Hydronephrosis; Infant; Kidney Pelvis; Retrospective Studies; Treatment Outcome; Ureteral Obstruction; Urologic Surgical Procedures
PubMed: 33218882
DOI: 10.1016/j.jpurol.2020.10.031 -
Pediatric Nephrology (Berlin, Germany) Oct 2023This review provides updated knowledge on the long-term outcomes among children with antenatally diagnosed urinary tract dilatation (UTD), previously often referred to... (Review)
Review
This review provides updated knowledge on the long-term outcomes among children with antenatally diagnosed urinary tract dilatation (UTD), previously often referred to as antenatal hydronephrosis. Different definitions of UTD exist, which makes comparison between studies and generalized conclusions difficult. Roughly, one-third of antenatally diagnosed UTD, defined as a renal pelvis anterior posterior diameter (APD) of ≥ 4 mm in the second trimester and/or ≥ 7 mm in the third trimester, will resolve before birth, another third will resolve within the first years of life, and in the remaining cases, UTD will persist or a congenital abnormality (CAKUT) will be diagnosed postnatally. The risk of a postnatal CAKUT diagnosis increases with the degree of prenatal and postnatal dilatation, except for vesicoureteral reflux (VUR), which cannot be predicted from the degree of UTD. Urinary tract infections (UTIs) occur in 7-14% of children with UTD during the first years of life. The risk of UTI is higher in children with traditional risk factors for UTI, such as dilated VUR, hydroureteronephrosis, female gender, and intact foreskin. Continuous antibiotic prophylaxis may be considered in selected patients during the first years of life. In long-term follow-ups, permanent kidney damage is diagnosed in approximately 40% of children with moderate or severe UTD, but hypertension, proteinuria, and/or reduced eGFR are uncommon (0-5%). In children with mild UTD, the long-term outcome is excellent, and these children should not be subjected to unnecessary examinations and/or follow-up.
Topics: Child; Humans; Female; Pregnancy; Dilatation; Vesico-Ureteral Reflux; Hydronephrosis; Urinary Tract Infections; Dilatation, Pathologic; Kidney Pelvis; Urinary Tract
PubMed: 36920569
DOI: 10.1007/s00467-023-05907-z -
British Medical Journal
Topics: Humans; Hydrogen-Ion Concentration; Hydronephrosis; Kidney
PubMed: 32953
DOI: No ID Found -
Praxis Jun 2013
Review
Topics: Adult; Algorithms; Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Hydronephrosis; Kidney Calculi; Male; Middle Aged; Referral and Consultation; Renal Colic; Risk Factors; Tomography, X-Ray Computed; Ultrasonography; Ureteroscopy
PubMed: 23773934
DOI: 10.1024/1661-8157/a001358 -
Folia Medica Cracoviensia 2019Hydronephrosis is an actual pediatric problem, affecting children in the ante- and neonatal periods. Intrinsic stenosis is due to external obstruction and creates a... (Comparative Study)
Comparative Study
INTRODUCTION
Hydronephrosis is an actual pediatric problem, affecting children in the ante- and neonatal periods. Intrinsic stenosis is due to external obstruction and creates a pathophysiological basis of this urological pathology. Co-localization of ureter with a renal vasculature also could not be omitted from this point of view. Mesenchymal cells, partially telocytes, are important for local fibrosis development and hydronephrosis formation as well. In the current study, we focused on identification of telocytes in the human ureters to hypothesize their role in hydronephrosis pathophysiology.
MATERIAL AND METHODS
the samples were taken from 18 surgically treated patients with hydronephrosis (due to ureteral obstruction and crossing renal vessel). The control group consisted of 10 patients suffered from a non-obstructive disease of the urinary tract - predominantly renal tumors. Tissue samples from a ureter were stained for c-kit, tryptase, CD34 and PDGFRα to identify telocytes. Routine histology was performed to analyze tissue morphology, collagen deposits and mast cell's profile.
RESULTS
Telocytes were detected in the ureteral wall. In patients with hydronephrosis we revealed decreasing density of telocytes, the prevalence of collagen, rise in mast cells amount and the ureteral wall thickening. In ureters with crossing renal vessels as a primary etiologic factor more telocytes have been observed in comparison with the obstructive hydronephrosis.
CONCLUSIONS
A declined density of telocytes accompanied hydronephrosis development. Increased number of mast cells in the ureteral wall reflects a local inflammation, while detailed observation of collagen/muscle deposits and density of telocytes reveal a difference depended on etiologic factor (obstruction or crossing vessel) in patients with hydronephrosis.
Topics: Child, Preschool; Female; Humans; Hydronephrosis; Infant; Male; Poland; Telocytes; Ureteral Obstruction
PubMed: 31891358
DOI: 10.24425/fmc.2019.131134