What is hydronephrosis? What is the treatment? Do I have to have surgery? What is the prognosis of hydronephrosis? What is hydronephrosis? Hydronephrosis is actually a general term, a descriptive diagnosis. All causes of fluid accumulation in the kidney are called hydronephrosis, and the common causes of hydronephrosis are pelvic ureteral junction obstruction (abbreviated as UPJO), duplicated kidney, obstruction at the ureteral entry into the bladder, ectopic opening of the ureter, vesicoureteral reflux and so on, and these disorders are congenital abnormalities of the structure of the urinary system. Of all these disorders, the most common is obstruction at the ureteropelvic junction (UPJO), and hydronephrosis is overwhelmingly caused by UPJO. Why do children get hydronephrosis? Is it congenital? Except for urinary stones and trauma-induced urinary tract obstruction, almost all other causes of hydronephrosis are caused by congenital developmental malformations of the urinary tract, and the vast majority of these hydronephrosis are caused by ureteropelvic junction stenosis. Therefore, pediatric hydronephrosis, the vast majority of congenital, many babies before birth, the mother’s prenatal ultrasound suggests the presence of hydronephrosis. Can hydronephrosis be hereditary? Will another child get hydronephrosis again? Many parents are concerned about whether hydrocele is hereditary or not, and worry whether another child will get hydrocele again. Current research has not found that hydrocele has a significant hereditary predisposition, and in real life, it is rare for a child born to a mother or father with hydrocele to have hydrocele, and also rare for a child with hydrocele to have hydrocele as a sibling. So the probability of having a baby with hydronephrosis and having another child with hydronephrosis is very low, just like winning the lottery, don’t worry too much. What are the symptoms of hydronephrosis? Clinically, most of the hydronephrosis is not much symptom, no pain, no itch, no feeling, a lot of prenatal ultrasound found hydronephrosis, but also have symptoms to the hospital to see, after the examination found hydronephrosis. The symptoms of hydronephrosis appear sooner or later and the severity of the obstruction is proportional to the severity of the obstruction (the more severe the blockage, the earlier the symptoms appear)． The more serious the obstruction is. The more severe the obstruction, the earlier the symptoms appear. Common symptoms are: 1, abdominal mass: this is very good to understand, the place of fluid accumulation bulging, some babies can feel the obvious ball-like, smooth surface of the mass. 2, intermittent pain in the lower back and abdomen: older children, can describe the location of abdominal pain. In the pain attack can be accompanied by nausea, vomiting． So some hydronephrosis is diagnosed as intestinal cramps. 3, hematuria: some children have hematuria. Especially after minor abdominal trauma. Or because of the increased pressure in the renal pelvis. Kidney medullary blood vessel rupture caused by, may also be due to urinary tract infections or complications caused by stones. 4, urinary tract infection: relatively rare, but once it happens, it will be more serious, there can be high fever, chills and sepsis. Serious fluid accumulation will become pus accumulation. 5.Hypertension: both pediatric and adult may have high blood pressure. It may be due to the expansion of the renal collecting system. Compression of intrarenal blood vessels causes a decrease in renal blood supply. Produce renin, which in turn causes hypertension (the mechanism is more complex, for the baby parents of pediatric hypertension, in any case, is to be vigilant). 6, kidney rupture, hydronephrosis is very serious if the hydronephrosis there is impact, hydronephrosis may lead to rupture. Severe abdominal pain, full abdominal pain and other manifestations. 7, if the serious hydronephrosis is not resolved in time, compression of renal tissue, renal atrophy, impaired function, the body’s toxins can not be discharged from the body in a timely manner, the manifestation of uremia, growth, developmental delay, feeding difficulties, anorexia and other symptoms of digestive compulsion disorders. What tests should be done for babies with hydronephrosis? How to follow up? Color ultrasound examination: whether the baby is in the fetal period or after birth, color ultrasound examination is very important for the diagnosis and follow-up of hydrocele. Ultrasound examination can find out: the degree of dilatation of renal pelvis, the degree of dilatation of renal calyxes, the size of kidneys, thickness of renal parenchyma, the echogenicity of renal parenchyma, the condition of ureters, the wall of the bladder and the condition of residual urine. Regular urological ultrasound examination, the regularity here, will be based on the doctor’s assessment decision, usually every 1 month to half a year ranging from the examination, close follow-up is very important. Imaging: Intravenous urography (IVP), after the contrast agent is injected into the blood vessel, it can pass through the kidney → renal pelvis → ureter → bladder in order to determine where the obstruction is. Excretory urography: first of all, catheterization is needed, and a catheter is inserted from the urethra, and the contrast agent enters the bladder through the urethra. Under normal circumstances, the contrast agent in the bladder will not retrograde into the ureter, but if there is vesicoureteral reflux, the contrast agent can retrograde into the ureter, or even into the kidneys, and vesicoureteral reflux, which is an important cause of hydronephrosis, the test can also detect urethral valves, ureteric terminal The test can also detect urethral valves, ureteral terminal cysts, bladder diverticula, and other causes of hydronephrosis or concomitant malformations. Retrograde ureteral ureterography: If the above tests still cannot make a clear diagnosis, a thin tube can be considered to be passed through the urethra → bladder → ureter → renal pelvis, and then a contrast agent is injected to make an image, so as to make clear whether there is any obstruction at the renal pelvis and ureter. CTU, MRU: CT or MRI is done after injecting contrast medium into the blood vessel to visualize the urinary tract. For the above tests, ultrasound is the most common and necessary, other tests are done only when necessary, if the hydronephrosis is ready to be operated, it needs to be examined more carefully, generally speaking, urography or CTU/MRU is necessary. Renal nuclear imaging: it can understand the function of the kidneys and the severity of hydronephrosis. In addition to the important tests mentioned above, the following tests are also needed to prepare for the surgery: 1, blood test, check the blood routine, biochemistry complete set (block liver function, kidney function, cardiac function, electrolytes, etc.), coagulation function, HIV, HCV, TPPA, Hepatitis B two halves, blood type, which are necessary to prepare for the surgery. 2. Urine routine. 3, Stool routine. 4.Electrocardiogram, cardiac ultrasound if necessary. 5, Chest orthopedic film. These tests are done for diagnosis and comprehensive pre-operative assessment of: the baby’s development and ability to tolerate surgery; combined malformations and possible effects on the baby after surgery. How is hydrocele treated? Is it treated surgically? Can minimally invasive surgery be done? What is the age for surgery? There is no way to solve the problem of hydronephrosis fundamentally by injections and medicines, it mainly depends on surgical treatment, but not all hydronephrosis needs surgical treatment. However, not all hydronephrosis requires surgery. Here, we mainly talk about the treatment of hydronephrosis caused by narrowing of pyeloureteral junction. For mild-moderate hydronephrosis, what is mild-moderate? It generally means that the diameter of the hydronephrosis is less than 3 cm. In this case, regular ultrasound examinations are performed in the outpatient clinic and follow-up. Many hydronephrosis have a tendency to heal on their own, and eventually get well on their own, or the hydronephrosis is so small that it doesn’t affect the body and can be left untreated. Of course, there are cases where the hydronephrosis worsens and requires surgical treatment. Which hydronephrosis requires surgery needs to be evaluated by specialized doctors according to the age of the child, the severity of hydronephrosis, and the degree of renal function impairment. The following conditions need to be actively considered for surgical treatment: hydronephrosis causing clinical symptoms (pain, urinary tract infection); hydronephrosis with renal function of less than 35%~40%; progressive aggravation of hydronephrosis, and progressive renal function impairment. How to do the surgery? Can it be minimally invasive? The name of the surgery for hydronephrosis caused by stenosis of pelvic-ureteral junction is called: Dissecting Pelvic Ureteroplasty. It is to remove the diseased stenotic segment and reattach it. Many parents are concerned about the minimally invasive surgery, the answer is yes, the above surgery is done under laparoscopy, there are only three small holes on the stomach, and the one in the belly button is almost invisible, and the intraoperative bleeding is also less. Postoperative follow-up and precautions: Postoperative application of ultrasound and diuretic renal nuclear imaging is recommended for follow-up and monitoring of blood pressure and urinary routine. It is recommended to perform urinary tract ultrasound every month for the first 3 months, 6 months, 1 year and every 1-2 years thereafter, and diuretic renal nuclear imaging is performed half a year to 1 year after the operation, if necessary. What is the prognosis of hydronephrosis caused by obstruction of the renal pelvic-ureteral junction? Overall the prognosis of hydronephrosis is still good, some hydronephrosis heal by themselves, and if surgery is needed, although there are some risks in surgery, the success rate of surgery is relatively high, and the overall prognosis is still good. In conclusion, babies with hydronephrosis are advised to follow up with their professional doctors, closely follow up with their doctors, and actively cooperate with the treatment, and don’t worry too much about it.