The enlargement of the collecting system where the kidneys fill with urine is called Hydronephrosis. Most of them are diagnosed by ultrasound performed while in the womb.
Ureteropelvic junction stenosis, Vesicoureteral reflux, ureterovesical junction stenosis, posterior urethral valve, ureterocele, and double system are detected in order of frequency.
Occurrence of hydronephrosis. The time of emergence, the cause of hydronephrosis, the presence of one or both sides, the severity of hydronephrosis are determined and it is determined whether there is damage to the kidneys. Önen Staging can be used to determine the severity of hydronephrosis.
According to ultrasound; Scintigraphy may be required to show kidney damage and functioning, and Voiding Cystourethrography to show bladder problems. Thus, stenosis or vesicoureteral reflux causing hydronephrosis is detected.
Ureteropelvic Junction Stenosis (UPD)
In ureteropelvic junction stenosis, stenosis at the junction of the renal pelvis and the ureter or compression of the vein feeding the kidney through the region connecting the renal pelvis to the ureter may narrow this region. In this case, since the urine produced cannot pass easily into the ureter, it accumulates in the kidney and causes hydronephrosis, urinary infection and kidney damage.
If a child with UP stenosis has complaints such as pain, urinary infection or stones, surgery can be performed. In babies without complaints, if the kidney parenchyma becomes severely thinned during ultrasound follow-ups or if kidney damage develops in scintigraphy, surgery may be required.
Ureterovesical Junction (UVD)
If there is a stenosis at the entrance (joining) of the ureter to the bladder, urine from the kidney accumulates in the ureter and cannot pass into the bladder easily. As a result, the ureter and kidney enlarge.
It may present with urinary infection after delivery. Sometimes it is discovered by chance during other examinations. In severe cases, scintigraphy may be required to look for kidney damage. Depending on the degree of swelling of the kidney and urinary tract detected on ultrasound, kidney damage on scintigraphy, the presence of urinary infection, and whether the swelling has one or both sides. Re treatment method varies.
Vesicoureteral Reflux (VUR)
Normally, the urinary channels enter the bladder through a tunnel through the muscle layer. This structure acts as a valve (valve). Thus, backflow of urine from the bladder towards the ureter and kidney can be prevented. This problem may go away on its own over time or may progress to serious kidney damage.
The most common cause of vesicoureteral reflux is congenital insufficiency of the tunnel in the bladder. In addition, due to some diseases, the pressure in the bladder increases seriously, disrupting this valve and VUR develops.
Especially in the presence of an infection in the bladder, it may cause permanent kidney damage as this infection reaches the kidney with the back flow of urine to the kidney.
Children with febrile urinary tract infections, severe voiding difficulties, or large ureters should be examined for reflux. The definitive diagnosis of VUR is made by voiding cystourethrography.
The treatment of vesicoureteral reflux varies depending on the age, degree of reflux, and cause of reflux in children. Surgery may be required in children who develop urinary infection or kidney damage despite antibiotics and that do not improve with waiting during follow-up.
Posterior Urethral Valve (PUV)
At the exit of the bladder, the first part of the urethra The curtain, which is located in the section of the bladder and makes it difficult to empty the bladder, is called the posterior urethral valve. It is seen in male infants. Because this curtain narrows the urethra, urine accumulates in the bladder. Hydroureteronephrosis and VUR develop by increasing intra-bladder pressure. Bladder, ureter and kidneys, that is, the entire urinary system, deteriorates because it significantly blocks the urinary flow due to stenosis in the lowest part of the urinary system. Therefore, it is a very serious condition.
Today, it is mostly diagnosed by prenatal ultrasound performed in the mother's womb. Frequent recurrent urinary tract infections develop after delivery in those who cannot be diagnosed during pregnancy. These infants typically urinate with difficulty, drop by drop, thin and intermittent. On ultrasound, the bladder wall thickens, hydroureteronephrosis develops. In the voiding cystourethrography taken for definitive diagnosis, the curtain (valve) is displayed during voiding. Thus, a definitive diagnosis is made.
Prenatal intervention may be required in some babies with very serious valves.
The diagnosis should be confirmed immediately after birth, and the bladder should be emptied by catheter, by taking emergency measures. Most children with PUV require lifelong follow-up and treatment.
Ureterocele and Ureteral Duplication
As a result of the closed end (mouth) of the ureter in the bladder, urine cannot pass into the bladder and consequently a bubble (swelling) that takes up space in the bladder ) shaped cystic enlargement is called ureterocele.
Ureterocele is a structural disorder. This is accompanied by kidney and bladder disorders.
The protrusion of 2 ureters from the same kidney is called Ureteral Duplication (Double ureter system). If there is a ureterocele at the end of one of these ureters or if the end of one of them opens to an organ other than the bladder, it causes a serious problem.
It may be associated with vesicoureteral reflux. Diagnosis is made by urinary ultrasound and voiding cystourethrography. Ureteral duplication is also mostly diagnosed by ultrasound.
The ureterocele is punctured with a cystoscopic incision. Thus, hydroureteronephrosis is relieved. In children with persistent urinary incontinence due to ureter duplication, the ureter opened in the wrong place is corrected by reimplanting the bladder.
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