hydro nephrosis during pregnancy
DESCRIPTION
Sometimes during pregnancy, there may be swelling of the kidneys called HYDRONEPHROSIS. Which can sometimes leads to complications in the mother and fetus. Contact female urology DOCTOR in Hyderabad to get best treatment, without effecting your baby’s growth.TRANSCRIPT
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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