Sometimes children have such an anomaly of the upper urinary tract as hydronephrosis. Usually, this disease is asymptomatic in its early stages. However, it is the diagnosis of hydronephrosis in the initial stages that makes it possible to avoid surgery.
What is this diagnosis – hydronephrosis?
The urinary system consists of a filter that performs the function of cleaning blood (kidney parenchyma) and urinary tract. The latter are divided into upper and lower. Hydronephrosis is a violation of the anatomy (structure) of the upper urinary tract, which includes two kidney structures – cups and pelvis. This structure can be compared with a tea set for six people, where the pelvis – it is a teapot, and the ureter rules for its spout – the tube connecting the kidney to the bladder. Fluid movement in our "service" begins from the parenchyma (filter), in which urine is formed. Then the liquid accumulates in the cups, moves to the "kettle" (pelvis) and, finally, along the "nose" (of the ureter) goes to the bladder.
What happens with hydronephrosis? The place of transition of the belly of the "kettle" in "spout" narrowed, and fluid (urine) does not completely exit the pelvis and cups. This is compensated by stretching the pelvis and cups, which increase in size. At the same time, the pressure in the kidney cavity increases, which causes the kidney filter to suffer so much that it begins to die. Moreover, the speed of parenchyma death is directly proportional to the degree of narrowing of the transition of the pelvis into the ureter and the degree of stretching of the cups and pelvis.
Unfortunately, the problem described above can be eliminated only by removing the narrowing between the pelvis and the ureter (surgically). But surgery is not always necessary. In some cases, with a low stage of hydronephrosis, the pathology passes by itself: the urinary tract matures, so the narrowing is eliminated.
Operation or observation?
Additional methods of examination help the urologist to draw a conclusion about the expediency of the operation. In the first place – ultrasound examination of the kidneys and bladder, thanks to which hydronephrosis can be suspected even in the womb. The main marker of this disease is the size of the expansion of the pelvis and cups, as well as the thickness of the renal filter (parenchyma).
If the thickness of the parenchyma is reduced, and the expansion of the pelvis and cups remains after the appointment of a diuretic drug, then X-ray diagnostics comes to help in the examination – excretory urography. This study provides the doctor with information about the function of the diseased organ, as well as an accurate assessment of its structure, namely – whether or not there is a narrowing at the transition point of the pelvis into the ureter.
Both studies are carried out in a polyclinic, they do not require hospitalization. Usually, these studies are enough to draw a conclusion: operate or limit yourself to observation. If the listed two diagnostic methods are not enough to establish a diagnosis, then there are three more methods in the arsenal of diagnostics: magnetic resonance imaging (MRI), computer tomography (CT) and nephroscintigraphy. The first two studies provide a more accurate assessment of the structure of the diseased kidney, and nephroscintigraphy provides accurate information about the function of the renal filter itself. The disadvantage of these studies is that in children of the younger age group they should be conducted in a state of medicated sleep.
Important! Hydronephrosis is insidious in that it is asymptomatic, while all laboratory parameters (analyses) may be normal. Therefore, ultrasound of the organs of the urinary system must be included in the preventive examination of the child.
Diagnosis revealed: what are the next steps?
If the examination confirmed hydronephrosis of the first stage, the doctor makes a decision to monitor the condition of the upper urinary tract. Observation consists in periodic control of urine analysis and control with the help of ultrasound with an interval of 3-6 months.
Stage 2-3 hydronephrosis requires surgery. It can be carried out by one of the following methods:
- Laparoscopic plastic surgery of the pelvic-ureteric joint – this operation is performed using special equipment through mini-incisions.
- Open plastic interventions on the pelvic-urethral segment with a mini-access (a 3-4 cm skin incision).
- Endoscopic urological interventions (buoyancy, balloon dilation, stenting).
After the operation, the child stays in the hospital for 2-3 days, then is observed at home. Re-examination is required only to remove the stent (a special tube on which the formed pelvic-ureteral connection heals). All postoperative wounds are covered with cosmetic stitches that do not need to be removed. Kidney anomaly is curable only if treatment is started in time!
To make an appointment with a doctor, contact the contact center of the "Dobrobut" MN< /p>
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