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HYDRONEPHROSIS HYDRONEPHROSIS DURING PREGNANCYDURING PREGNANCY
Dr. LALITHADr. LALITHAUROLOGIST AND UROGYNECOLOGISTUROLOGIST AND UROGYNECOLOGIST
YASHODA HOSPITALYASHODA HOSPITAL
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• INCIDENCE 95%
• CAUSE OF ANXIETY
• PATIENTS
• OBSTETRICIANS
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F.A.Q.sF.A.Q.s
• CLINICAL PRESENTATION?
• INTERVENTION?
• WHEN?
• WHAT?
• PROGNOSIS? - MATERNAL/FETAL
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ETIOPATHOGENESISETIOPATHOGENESIS
•
• PHYSIOLOGICAL
• PATHOLOGICAL
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PHYSIOLOGICAL PHYSIOLOGICAL HYDRONEPHROSISHYDRONEPHROSIS
• HORMONAL
• MECHANICAL• RARE IN 1ST TRIMESTER
• DILATATION OF UPPER URETER• PELVIC KIDNEY• QUADRIPEDS
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PHYSIOLOGICAL PHYSIOLOGICAL HYDRONEPHROSISHYDRONEPHROSIS
• RIGHT > LEFT
• DEXTROROTATION
• RIGHT OVARIAN VESSELS
• LEFT – PROTECTION BY SIGMOID COLON
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PATHOLOGICAL PATHOLOGICAL HYDRONEPHROSISHYDRONEPHROSIS
• CALCULI• PUJ OBSTRUCTION• OBSTRUCTED MEGA URETER• VU-REFLUX• NEUROGENIC BLADDER - RARE
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CLINICAL PRESENTATIONCLINICAL PRESENTATION
• ASYMPTOMATIC• PAIN – DULL / COLICKY• VOMITING• FEVER WITH CHILLS• HEMATURIA• OLIGURIA / ANURIA
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DIAGNOSISDIAGNOSIS
• ULTRASONOGRAPHY• HYDRONEPHROSIS
• HYDROURETER – UPPER / LOWER• CALCULI – RENAL / PUJ / URETER• PARENCHYMAL THICKNESS• URETERIC JET• RENAL RESISTIVE INDEX
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DIAGNOSISDIAGNOSIS
• IVP – OBSOLETE
• MR UROGRAPHY• TO DIFFERENTIATE PHYSIOLOGICAL FROM CALCULUS
• HYDRONEPHROSIS
• DOUBLE KINK SIGN – SPINDLE SHAPED PELVIC URETER
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MANAGEMENTMANAGEMENT
• CONSERVATIVE• SCREENING FOR BACTERIURIA• RISK OF PYELONEPHRITIS IN 28-30%
• ANTIBIOTICS / ANALGESICS
• PERIODIC URINE CULTURES• SERIAL CREATININE / USG MONITORING
• SUPPRESSANT ANTIBIOTIC THERAPY
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INDICATIONS FOR SURGICAL INDICATIONS FOR SURGICAL INTERVENTIONINTERVENTION
• SYMPTOMATIC PATIENTS NOT RESPONDING TO DRUGS.
• RECURRENT PYELONEPHRITIS
• OLIGURIA / ANURIA
• INCREASED S.CREAT [>0.8]
• PROGRESSIVE HYDRONEPHROSIS
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TYPE OF INTERVENTIONTYPE OF INTERVENTION
• CYSTOSCOPY & DJ STENTING
• URETEROSCOPIC STONE REMOVAL
• URETEROSCOPIC PUSH BACK & DJ STENTING
• USG GUIDED PCN
• ESWL CONTRAINDICATED
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OUR EXPERIENCEOUR EXPERIENCE
• 96 CASES IN LAST 5 YEARS
• 18 REQUIRED SURGICAL INTERVENTION
• 6 – PHYSIOLOGICAL
• 9 – CALCULUS 6 – LOWER URETER
3 - UPPER URETER / PUJ
3 – PUJ OBSTRUCTION - BILAT.
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FOLLOW UPFOLLOW UP
• DJ STENT REMOVAL DEPENDS ON INDICATION• 3 WEEKS FOR URSL• 6 WEEKS PP FOR PHYSIOLOGICAL
• FU MANDATORY IN INTERVAL PERIOD• SCREENING USG / IVP
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AIMAIM
• BYPASS OBSTRUCTION
• RELEIVE STASIS
• IMPROVE MATERNAL & FETAL PROGNOSIS