← All decks
Paediatric Surgery
Antenatal Hydronephrosis
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
10 sections · 69 slides
Overview
- What this talk will teach you
The Basics
What antenatal hydronephrosis is, and why we care
- What is antenatal hydronephrosis (AHN)?
- Why it matters — and often doesn’t
- Three broad groups a dilated fetal kidney falls into
Seeing It Before Birth
Prenatal imaging and its limits
- How prenatal imaging picks up dilation
- When ultrasound isn’t enough: fetal MRI
Grading Systems
Turning a picture into a risk number
- Why we need a grading language
- APD – the simple ruler measurement
- Setting an APD threshold: a trade-off
- The Great Ormond Street surgical trial (Dhillon 1998)
- SFU grading of hydronephrosis (Fernbach 1993)
- SFU grading – reading the kidney’s shape
- Does SFU grade predict who needs surgery? (Ross 2011)
- UTD – the 2014 unifying system
- UTD prenatal risk stratification
- What the UTD prenatal tier tells you to do
Intervening Before Birth
Lower urinary tract obstruction – rare, high-stakes
- Spotting fetal LUTO
- Why amniotic fluid is the real prize
- The three ways to intervene in utero
- Fetal urinary markers suggesting poor kidney prognosis
- Reading fetal urine to judge kidney health
- The PLUTO trial — key evidence, with caveats
- Shunt versus fetal cystoscopy (Ruano 2015–2016)
After Birth: The Work-up
Which baby needs which test
- A more evidence-based, risk-tailored era
- First postnatal ultrasound: wait 48 hours
- Postnatal UTD grading (P1–P3)
- How fast does the dilation resolve?
- VCUG – the test for backflow (reflux)
- Renal scintigraphy (MAG-3): function & drainage
- MRU – detail without radiation
After Birth: Management
Matching action to the P1–P3 risk
- P1 UTD (low risk) – do less, confidently
- P2 UTD (intermediate risk) – the grey zone
- P3 UTD (high risk) – the clearest protocol
- Severe bilateral dilation — an emergency
Infection & Prophylaxis
The main threat to a dilated kidney
- How often does infection actually happen?
- Who is most likely to get infected?
- Antibiotic prophylaxis (AP) – a genuine controversy
The Causes Behind the Dilation
A tour of the specific diagnoses
- Etiology of antenatal hydronephrosis
- Transient / physiologic HN — the commonest
- UPJO-like hydronephrosis – the top surgical cause
- UPJO-like HN – who actually needs the operation
- Vesicoureteral reflux (VUR) – urine washing backward
- VUR – conflicting registry evidence
- Primary megaureter / UVJ obstruction
- BAPU 2014 consensus on primary obstructive megaureter
- LUTO umbrella: PUV, prune belly, atresia
- Posterior urethral valves (PUV) – the leading LUTO
- Prune belly syndrome vs urethral atresia
- Congenital megacystis – two very different forms
- Multicystic dysplastic kidney (MCDK)
- Duplication anomalies: ureterocele & ectopic ureter
Bringing It Together
Key takeaways and the road ahead
- A newborn boy has bilateral hydroureteronephrosis, a distended bladder, and oligohydramnios. First concern and action?
- Ten things to remember
- Conclusion and future directions
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology