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[A clinical study of intermittent hydronephrosis]
S Matsumoto1, K Shimada, S Hosokawa
1Division of Urology, Osaka Medical Center.
Insights
Intermittent hydronephrosis in children, often caused by ureteropelvic junction obstruction, presents with flank pain and vomiting. Prompt diagnosis using ultrasonography and diuretic renography is crucial for effective treatment and symptom relief.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Intermittent hydronephrosis is a rare condition in children.
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in pediatric patients.
- Diagnosing intermittent UPJ obstruction can be challenging due to its variable presentation.
Purpose of the Study:
- To evaluate the diagnostic utility of ultrasonography and diuretic renography in children with intermittent hydronephrosis.
- To identify the causes and clinical features of intermittent hydronephrosis in a pediatric cohort.
Main Methods:
- A retrospective review of 5 children diagnosed with intermittent hydronephrosis between 1991 and 1995.
- Analysis of presenting symptoms, diagnostic imaging (ultrasonography, diuretic renography), and surgical findings.
- Assessment of postoperative outcomes.
Main Results:
- Five pediatric patients (all boys, aged 6 months to 6 years) presented with intermittent flank pain and vomiting.
- Ultrasonography during symptomatic episodes revealed renal pelvis dilation in all patients.
- Diuretic renography confirmed obstruction in 4 patients and indicated renal function decline in 2.
Conclusions:
- Ultrasonography during symptomatic attacks and diuretic renography are valuable tools for diagnosing intermittent hydronephrosis.
- Surgical intervention for UPJ obstruction in these cases led to complete pain relief.
- Early diagnosis and management are essential for improving outcomes in pediatric intermittent hydronephrosis.
Abstract:
A clinical study was conducted on the intermittent hydronephrosis in children. Of 78 children with hydronephrosis due to ureteropelvic junction obstruction operated between 1991 and 1995, 5 had intermittent hydronephrosis. All 5 patients were boys between 6 months and 6 years of age. Presenting symptoms were intermittent flank pain and vomiting. Ultrasonography performed during pain attack demonstrated dilation of the renal pelvis in all patients. Diuretic renography demonstrated obstruction in 4 of the 5 children and deterioration of renal function on the affected side in 2. The cause of ureteropelvic junction obstruction was aberrant vessels in 2 cases, fibrous band in 1, ureteral kinking within adventitia in 1 and a ureteral polyp in 1. Postoperatively, all patients have been relieved from the pain. In summary, ultrasonography at the time of symptom attack as well as diuretic renography are useful for the diagnosis and observation of intermittent hydronephrosis.