Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)

Index Cases

A newborn with Antenatal Hydronephrosis and Pelvi-ureteric junction obstruction

Master M.T. was diagnosed to have Antenatally diagnosed hydronephrosis (kidney swelling diagnosed before birth by ultrasound (USG) of the pregnant mother) in 7th month of intrauterine life (30 weeks) on a routine Antenatal USG. The hydronephrosis was unilateral (AP diameter of pelvis 16mm) and the right kidney was normal. There were no other abnormalities detected. Parents were counseled and pregnancy was followed up and a repeat USG was advised at 36 weeks. The swelling on the left side had increased (AP diameter of pelvis- 22mm).

Baby was delivered at term by normal vaginal delivery and passed urine in day 1. On clinical examination there was no lump palpable. A repeat USG at one week of age showed persistent hydronephrosis on left side with AP diameter of 20mm. A Nuclear Renal scan to determine renal function and also drainage was done at 4 weeks of age showed Left PUJ obstruction with non-draining curve and significant retention of tracer even at 2 hours (see picture). Fortunately, the renal function was preserved (LK-46%, RK-54%). Baby was kept on close follow-up as there were chances that he may require surgery. A USG was again repeated at 2 months of age and it showed worsening hydronephrosis with AP diameter of 30mm. There was some cortical thinning also with calyceal dilatation. A detailed discussion was held with parents and a decision for pyeloplasty (Surgery to correct the obstruction) was made.

Before surgery a cystoscopy and retrograde pyelogram was done to delineate the anatomy more clearly- it confirmed pelvi-ureteric junction obstruction (see picture). Pyeloplasty was completed uneventfully and baby was discharged after 3 days. A small indwelling tube called DJ stent was left inside the kidney to allow for good healing and faster discharge. DJ stent was removed after 6 weeks by cystoscopy. A follow-up USG at 3 months showed reduction of hydronephrosis and a nuclear scan at 6 months showed normalization of drainage curves and minimal retention in delayed images (see picture 3).

Renal scan showing PUJ Obstruction
DTPA scan showing Left PUJO, there is significant retention of tracer even at 2 hours. Curve is non-draining type
RGP showing narrow PUJ
DTPA scan 6 months after surgery showing good drainage and normal drainage curve.
Normal Scan after pyeloplasty surgery
Rterograde pyelogram showing features of Pelviureteric Junction Obstruction

Facts about Antenatal Hydronephrosis

Pediatric Urology centre at MITR Hospital, Kharghar, Navi Mumbai (near Panvel) provides best treatment for kidney swelling due to PUJ Obstruction in children and adults. Dr A.K.Singal personally manages children who come with pelvi-ureteric junction obstruction to his clinic and provides best quality treatment options for surgery. Dr Singal is well renowned in conducting laparoscopic kidney surgery in small children for best results for PUJ obstruction. Dr Singal has done more than 500 laparoscopic pyeloplasty surgeries in last 15 years with close to 99% success rate.

Watch video of Laparoscopic Pyeloplasty surgery by Dr Singal here: Laparoscopic Pyeloplasty in a child- Video

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