Title: Ultrasonographic Evaluation of Foetal Hydronephrosis
Authors: Dr Josey Verghese, Dr Kishore Mandal, Dr Sajitha, K, Dr Suma Job
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.171
Abstract
Objectives: Hydronephrosis is commonly detected during routine ultrasound examination of antenatal mothers. There are multiple conflicting prognostic factors in the available literatures with no clear focus on the postnatal outcome. The aim of this study is to assess the outcome of antenatally diagnosed hydronephrosis, based on third trimester antanatal ultrasonography.
Materials and Methods: Based on the third trimester fetal ultrasound findings, patients were divided into group I (unilateral hydronephrosis) and group II (bilateral hydronephrosis, ureteric dilatation, bladder wall thickening etc.). Postnatal evaluation and follow-up was performed following a uniform protocol. The outcomes, spontaneous resolution vs. surgical intervention, were compared between groups. These two groups were further subdivided into subgroups on the basis of third trimester ultrasoung findings and further analysis of outcome was carried out.
Results: Among a total no of 53 patients in this study group; group I had 39 patients, 5(13%) required surgery; group II had 14 patients, 4(28%) required surgery. The difference in outcome between the groups was statistically significant ( p=0.01). Among those with unilateral hydronephrosis, none(0/39) with renal anteroposterior pelvic diameter (APD) <15 mm required surgery, while 2 out of 2 patients(2/2) with fetal APD >30 mm required surgery. In those with APD between 15-30 mm, 3 out of 8 (3/8) required surgery and prolonged follow-up was required to arrive at the decision. The difference in outcome between the subgroups was statistically significant ( p=0.001, Chi-square test). Group II had two subgroups. Subgroup I consisted of patients with APD < 15 mm with or without ureteric dilatation and bladder wall thickening , whereas subgroup II consisted of cases with APD >/= 15 mm with or without ureteric dilatation and bladder wall thickening. Of 10 cases in subgroup I, 1 (1/10) needed surgical intervention and 3 out of 4 cases (3/4) of subgroup II, needed surgery. The difference in outcome between these two groups was statistically significant (p=0.002, Chi-square test).
Conclusions: The results of our study show that simple unilateral fetal hydronephrosis runs a benign course. In the presence of hydronephrosis larger than 15 mm, bilateral disease or ureteric dilatation, detailed postnatal evaluation and regular follow-up is warranted to plan a timely intervention.
Keywords: Hydronephrosis, Antenatal ultrasonography, Anteroposterior pelvic diameter.
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Dr Josey Verghese
Department of Radiodiagnosis, Govt.T.D Medical College, Alappuzha, Kerala, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it. PH: 9447342889, FAX: 04772282368