Saima Ali, Liaqat Ali.
Etiology and postnatal management of prenatal hydronephrosis: a study of two teaching hospitals of Khyber Pakhtunkhwa.
Pak J Med Res Jan ;53(2):39-41.

Background: Hydronephrosis is the most common abnormal finding in the urinary tract during prenatal ultrasonography screening. It is important to differentiate between obstructive and physiologic hydronephrosis because obstructive pathology may lead to recurrent urinary tract infection and end stage renal disease. Objectives: To determine the aetiology of prenatal hydronephrosis and see its outcome following treatment at two teaching hospitals of Khyber Pukhtoon Khawa. Study type, settings and duration: This descriptive retrospective study was conducted in Department of Paediatrics in Kuwait Teaching Hospital, Peshawar and Department of Urology in Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar from January 2008 till December 2010. Patients and Methods: A total of 64 neonates were included in the study with a mean follow up of 14.5 months. Data of antenatal ultrasound, postnatal ultrasound, clinical features, urea, creatinine, voiding cysto-urethrogram, renal scan and operative and non operative information was collected on structured Proforma and was analyzed on SPSS version 17. Results: Out of 64 neonates, 39 were males and 28 females. Ultrasonography showed unilateral hydronephrosis in 52 patients and bilateral in 12. Based upon prenatal ultrasonography using Antrerio posterior diameter, 37 patients had mild hydronephrosis, 14 had moderate and 13 had severe hydronephrosis. Etiologically 44 patients had physiologic hydronephrosis, 11 pelvi-ureteric junction obstruction, 5 vesicouretric reflux and 4 posterior urethral valves. Surgery was performed in 15 patients which included open pyeloplasty in 11, vesicostomy followed by posterior valve fulguration in 4 patients. All patients vesicouretric reflux were treated medically. The severity of prenatal hydronephrosis was significantly associated with need for definitive urological surgery (p<0.005). Ancillary procedures like percutaneous nephrostomy were inserted in 7 patients. Conclusion: Physiological hydronephrosis and vesicouretric reflux can be successfully treated with medical treatment. However, obstructive pathology requires surgical correction.

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