Can micturating cystourethrograms be avoided in follow-up of antenatally diagnosed hydronephrosis?

Chawla, Arun and Reddy, Sreedhar and Thomas, Joseph (2008) Can micturating cystourethrograms be avoided in follow-up of antenatally diagnosed hydronephrosis? Indian Journal of Urology, 24 (1). pp. 132-133. ISSN 0970 - 1591

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Micturating cystourethrogram (MCUG) is advocated in all patients with antenatally detected hydronephrosis to diagnose vesicoureteral reflux (VUR). In this study, the authors have tried to identify if MCUG is really needed for all these patients. They followed 55 children with antenatal hydronephrosis (ANH) by adopting a selective approach to performing MCUG. Ultrasound examination was done at one week for all unilateral hydronephrosis. It was done at two to three days postnatally in patients with bilateral hydronephrosis. All these patients were periodically followed up every two to three months by ultrasound. If the Antero-posterior (AP) diameter was more than 15 mm or more than 10 mm with calyceal dilatation on two months' ultrasound, Mercapto-acetyl Triglycine-3 renogram was done to rule out pelviureteric junction (PUJ) obstruction. None of the patients with AP diameter of less than 10 mm had antibiotic prophylaxis. In this study, 29 patients had MCUGs done to rule out VUR, based on the presence of any of the following ultrasound findings: bilateral hydronephrosis, ureteric dilatation, renal scarring, bladder wall thickness greater than 5 mm or presence of duplex system or ureterocele. Out of these only eight patients had VUR, of which resolution occurred in five cases. The remaining three patients did not require reimplantation of ureter. However, surgical correction was needed in one patient who underwent bilateral pyeloplasty and two who needed upper pole heminephrectomies. In 26 patients of ANH, followed without MCUGs, 18 had spontaneous resolution, five required pyeloplasty for increasing hydronephrosis and three had Multicystic Dysplasia of Kidneys (MCDK) on follow-up scans. Minimum follow-up in this study was three years. The authors believe that VUR in most antenatally diagnosed hydronephrotic kidneys is more physiological than pathological and hence resolves without long-term renal damage. More conservative approach to postnatal investigations of ANH reduces the number of unnecessary tests like MCUGs and does not result in missed renal scars.

Item Type: Article
Subjects: Medicine > KMC Manipal > Urology
Depositing User: KMC Manipal
Date Deposited: 31 May 2012 05:12
Last Modified: 31 May 2012 05:12

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