Management
hydroureteronephrosis uvj obstruction
When a baby is born with a blockage in the area where the ureters meet the bladder, the diagnosis is ureterovesical junction obstruction (UVJ), also known as a megaureter. This is a congenital condition, diagnosed by a prenatal ultrasound that shows swelling of the kidneys & ureter (hydroureteronephrosis).
Once antenatal hydroureteronephrosis due to UVJ obstruction is diagnosed, the aim is to monitor the effect on kidneys. However, early diagnosis and treatment can prevent damage to kidneys. We sometimes take a wait-and-see approach with a newborn who is diagnosed with UVJ.
The symptoms include urinary tract infection, nausea, vomiting, fever, bloody urine,and side pain.
Once a baby is born, we fully assess the anatomy and the severity of the condition.
The tests done-
- Blood tests.
- Voiding cystourethrogram (VCUG).
- Renal scan. This is a nuclear scan to check kidney function and the ability of the kidneys to drain.
If swelling in the kidneys and ureter(s) does not subside or the kidneys begin to deteriorate, surgery is necessary. The permanent surgery to repair UVJ—ureteral reimplantation—removes the damaged section of the ureter(s) and reattaches the healthy portion to the bladder. This can be done either laparoscopically or by open surgery.
Sometimes, diversion surgery is necessary because the bladder is not large enough to handle ureteral reimplantation.
Ureterostomy
Once a child is mature enough—usually between 18 months and two years of age—surgeons can reimplant the ureter.
Most children recover from surgery quickly and have few, if any, issues afterwards. These patients will be followed with renal bladder ultrasounds regularly and typically have a greater than 90% success rate.