Outcome of antenatally diagnosed
hydronephrosis- our series
VIJAYANAND, VENKATA SAI,
RAMESH BABU S, SUNIL SHROFF,RAJAMANIKAM
Paediatric Urology & Paediatric Nephrology Units
Departments of Radiology & Urology
SRI RAMACHANDRA MEDICAL COLLEGE AND
RESEARCH INSTITUTE, CHENNAI
INTRODUCTION

Ultrasonogram has become a routine imaging modality to
diagnose congenital anomalies.

Hydronephrosis is one of the common anomaly detected in the
fetus

Incidence of antenatally detected hydronephrosis 2 – 4 %

Antenatal diagnosis of hydronephrosis causes a significant
distress to the parents during pregnancy.
INTRODUCTION

Antenatal counseling is being done regularly these days.

It is important to know the natural history of the
disease to give the parents an idea of what they can
expect .

The existing literature on the outcome of antenatal
hydronephrosis are unclear.
AIMS AND OBJECTIVES

To asses the outcome of antenatally diagnosed hydronephrosis
in our series of patients.

To find out which children would require early surgical
intervention, and who would require follow up evaluation.

To create a guideline for antenatal counseling based on our
findings.
Materials and methods


The study was conducted for 5 years from 2003 to 2008.
All the patients who were seen in our hospital with antenatally
diagnosed hydronephrosis were included in the study.
Materials and methods

The patients were followed up throughout the course of
pregnancy and after birth.

Post natal evaluation included ultrasound (1-3 monthly)

Whenever indicated MCU, DTPA performed

Patients were followed from 1 to 4 years with a median follow up
of 2.4 years.
Patient Groups

The patients were divided into two groups based
on fetal USG,
 Group I - Isolated unilateral hydronephrosis.
 Group
II – Hydroureter, bilateral
involvement, bladder wall thickening.

The outcome between groups were compared.
Fetal hydronephrosis
Unilateral, isolated (PUJ)
Bilateral, HUN, Bladder abnormality
USG at 24 Hrs
USG at 72 Hrs
AP diameter
<15mm
USG /
3 monthly
followup
15-25mm 25-40mm
Monthly
USG
DTPA
Improves  Follow up
>40mm
surgery
MCU
Intervention
(PUV, Ureterocele)
RESULTS

2003- 2008

Total number of patients registered
- 140

Defaulters for follow up
- 24

Total included patients
- 116

Group I
Group II
- 78
- 38

(Isolated hydro)
(HUN, bilatera)
Fetal Ultrasound
Unilateral hydronephrosis
Post Natal Ultrasound
Post natal USG
Post natal HUN
OUTCOME OF ANTENTAL HYDRONEPHROSIS

Group I- Isolated
hydronephrosis (n= 78)
 Required surgery 7 (9%)
80
70
60
50
40

Group II – HUN, Bilateral 30
20
(n=38)
10
 Required surgery 21 (55%) 0
Group I

Fisher’s exact test
P = 0.002 (significant)
Group II
Group 1: Isolated Hydronephrosis (PUJ)
7/78 required surgery
Size
Total number
Surgery required
< 15 mm
55
NIL
16 – 25 mm
12
1
26 – 40 mm
7
2
> 40 mm
4
4
Chi-square test P < 0.001
Outcome in group II
21/38 required surgery
Cause
Total number
Surgery required
PUV
12
12
VUR
22
5
VUJ obstruction
3
3
Ureterocele etc
1
1
Conclusions

Group 1: Isolated fetal hydronephrosis
 Vast majority are minimal hydronephrosis which resolve
spontaneously
 Only 9% require surgery

Group II: Ureterohydronephrosis, Bilateral etc
 55% required intervention
 PUV, VUJ, Ureterocele etc
Conclusions
The parents of fetuses with isolated fetal
hydronephrosis could be favorably counselled.
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