The most critical point in the postnatal evaluation of a patient with antenatal hydro-nephrosis is to diagnose the patients whose re-nal fonctions are at risk in an early stage and to plan the follow-up and treatment modalities in this group of patients. However, routine radio-logical evaluation of every patient with antana-tal hydronephrosis carries the risk of radiation with additional cost. Moreover, performance of voiding cysto-urethra graphy, for the diagnosis of vesicoureteral reflux, causes anxiety for both the patient and the parents.
The postnatal evaluation and management of patients with antenatal hydronephrosis vary depending on the degree of hydronephrosis, the presence of associated anomalies, the differen-cial renal functions and the clinical findings of the patient.
Isolated mild antenatal hydroneph-rosis usually regresses spontaneously. The latest consensus suggests that extensive radiological evaluation and antibiotic prophylaxis in asym-pthomatic patients with mild antenatal hydro-nephrosis are not necessary. However, the in-sidence of significant urological pathologies in moderate and severe antenatal hydronephrosis is high. Therefore, diagnosing the underlying pathologies such as ureteropelvic junction obs-truction, vesicouereteral reflux and posterir urethral valv in the early period and planning the management strategies are important to prevent the upper urinary tractus. Patients with vesicoureteral reflux and ureteropelvic junction obstruction are either operated or conservatively followed-up depending on the risk factors affecting the renal functions of the patient. Open surgical techniques for the treatment of vesicouereteral reflux and ureteropelvic junction obstruction are very successful. However, the same success rates have also been re-ported recently by minimal invazive surgery.
Key Words: Antenatal hydronephrosis, postnatal manage-ment, ureteropelvic junction obstruction, vesicoureteral reflux, posterior uretral valv
Abstract
The most critical point in the postnatal evaluation of a patient with antenatal hydro-nephrosis is to diagnose the patients whose re-nal fonctions are at risk in an early stage and to plan the follow-up and treatment modalities in this group of patients. However, routine radio-logical evaluation of every patient with antana-tal hydronephrosis carries the risk of radiation with additional cost. Moreover, performance of voiding cysto-urethra graphy, for the diagnosis of vesicoureteral reflux, causes anxiety for both the patient and the parents.
The postnatal evaluation and management of patients with antenatal hydronephrosis vary depending on the degree of hydronephrosis, the presence of associated anomalies, the differen-cial renal functions and the clinical findings of the patient.
Isolated mild antenatal hydroneph-rosis usually regresses spontaneously. The latest consensus suggests that extensive radiological evaluation and antibiotic prophylaxis in asym-pthomatic patients with mild antenatal hydro-nephrosis are not necessary. However, the in-sidence of significant urological pathologies in moderate and severe antenatal hydronephrosis is high. Therefore, diagnosing the underlying pathologies such as ureteropelvic junction obs-truction, vesicouereteral reflux and posterir urethral valv in the early period and planning the management strategies are important to prevent the upper urinary tractus. Patients with vesicoureteral reflux and ureteropelvic junction obstruction are either operated or conservatively followed-up depending on the risk factors affecting the renal functions of the patient. Open surgical techniques for the treatment of vesicouereteral reflux and ureteropelvic junction obstruction are very successful. However, the same success rates have also been re-ported recently by minimal invazive surgery.
Key Words: Antenatal hydronephrosis, postnatal manage-ment, ureteropelvic junction obstruction, vesicoureteral reflux, posterior uretral valv