Clinical Analysis On Congenital Hydronephrosis In Children

Objective:To approach the clinical diagnosis and management for congenital hydronephrosis in children.Methods:From May 2008 to April 2011, the clinical data of 513 children with congenital hydronephrosis were collected in the Affiliated Children's Hospital of Soochow University, in which 103 children with congenital hydronephrosis were hospitalized,83 children underwent surgical intervention. To review the 83 children who underwent surgical intervention especially. The clinical diagnosis and management of a child with congenital hydronephrosis due to UPJO coexisting with UVJO were analyzed in detail.Results:Of 513 children with congenital hydronephrosis collected in the Affiliated Children's Hospital of Soochow University,103 children with congenital hydronephrosis were hospitalized, in which 83 children (16.2%) underwent surgical intervention. There were 66 cases (12.9%) of Anderson-Hynes pyeloplasty,5 cases (0.97%) of nephrectomy, 8 cases (1.56%) of ureteral reimplantation and so on. Except the children for surgical intervention, there were 430 (83.8%) children with SFU grades 1 and SFU grades 2, who were under regular follow-up and watchful waiting.384 children (74.9%) were stable and resolutive. There were 27 children with SFU grades 3 and 39 children SFU grades 4 in 66 cases of Anderson-Hynes pyeloplasty. There were 3 children with severe hydronephrosis and nonfunction,a child with renal hypoplasia and a child with duplication of kidney in 5 cases of nephrectomy.81 cases of ECT were done in 83 children who underwent surgical intervention, in which there were 76 children with unilateral congenital hydronephrosis. There were 7 cases (8.64%) (differential renal function more than 55%) among these 76 children. In one case (0.19%) of children with congenital hydronephrosis due to UPJO coexisting with UVJO, the child was diagnosed as left UPJO by clinical manifestation and imaging examinations. The child underwent left Anderson-Hynes pyeloplasty. The antegrade nephrography showed that the second obstruction coexisted in distal end of ureter three weeks after surgical intervention. The child underwent left ureteral reimplantation one month after the first operation. The antegrade nephrography showed that left UPJO and left UVJO were relieved after left ureteral reimplantation. Both UPJO and UVJO were pathologically confirmed. The postoperative ultrasound showed improvement of hydronephrosis one month after the second operation.Conclusions:1,Regular follow-up observation of hydronephrosis progression,multitude imaging examinations and clinical manifestation are all significant to determine whether surgical intervention or not.2,ECT could not reflect differential renal function absolutely. Especially supranormal differential renal function is real, but the mechanism is not illuminated completely.3,The indication of nephrectomy is still under argument, so that we should handle it carefully.4,The case with congenital hydronephrosis due to UPJO coexisting with UVJO is rare in clinic. The imaging examinations can showed the characteristic of UPJO, while it is difficult to diagnose the second obstruction coexisted in distal end of ureter.5,The appearances with congenital hydronephrosis due to UPJO coexisting with UVJO in chiidren include:severe hydronephrosis and obstruction; IVU show nonvisulization of differential kidney and ureter; ECT show severe differential renal function injury.