Hydronephrosis is dilatation of part of the kidney. Generally it’s due to the fact there is slow or sluggish drainage in part of the kidney, down to the ureter.
Most children do not present with any signs or symptoms for unilateral hydronephrosis. Historically the most common symptom for hydronephrosis is in fact a urinary tract infection. The symptoms of urinary tract infection in the older child can consist of high temperature, pyrexia and dysuria (pain when voiding). There could be cloudy urine, blood in the urine and pain in the child’s side or their back. Younger babies will not necessarily present with clear symptoms and when they develop a urinary tract infection they can have high temperature, irritability and failure to thrive.
Presently a vast majority of children are diagnosed with hydronephrosis on fetal scans. At present, the 20 weeks scan can be useful for detecting hydronephrosis and this frequently means there may be further ultrasound scans required in pregnancy. This can occur at approximately 1 – 2% of all pregnancies.
In the occasion of unilateral hydronephrosis, the baby will require an ultrasound scan after the child is born. In certain situations preventable antibiotics which will decrease the severity of infections will potentially be of benefit. In this situation your child will need some further investigations to see what is going on.
Phimosis is when the foreskin can not be retracted from the tip of the penis. A vast majority of young boys have what’s called physiological phimosis. This means it’s a normal variation. When the boy is born the foreskin is partially attached to the top of the penis. It can take time for this to release and for the glans of the penis to become visible.
Most young boys will start to find that their foreskin starts to retract and by adolescence the vast majority of boys have a fully retractile foreskin.
Phimosis can occur however when the foreskin has already been pulled back. This is when the tissue becomes scarred and fibrous and stops the foreskin from retracting properly.
Depending on the ultrasound scan and MAG3 findings and their symptoms, some children will require surgery to improve drainage of their kidney. Usually procedure which is preformed is a pyeloplasty. This is an operation to remove the small narrowed area between the pelvis of the kidney and the ureter which is called the pelvi ureteric junction (PUJ). Once this is removed, two tubes are joined back together and a small stent is left internally. This is removed a number of months later.
Most children are able to go home the following day and some children will require two nights in hospital. In general, if the child is already on preventive antibiotics, they will remain on antibiotics until the stent is removed. A vast majority of children are very comfortable following the surgery. Once the stent is removed, the child will have a number of ultrasound scans and further MAG3 the following year to ensure their systems are working at the maximum capacity. After this, most children do not require further follow-up.
Hydronephrosis is very commonly seen on antenatal scans. A vast majority of people’s prenatal scans, one kidney can appear larger than normal. Normally this resolves in its own time and is due to alterations in either the flow or anatomy of the kidney.
Hydronephrosis can also be caused by stones or previous surgery and can be caused by other rare conditions.
In this situation your child will need some further investigations to see what is going on. They will require at least an ultrasound scan of the kidneys and a micturating cystourethrogram (MCUG). They will also require a nuclear medicine which is called a DMSA scan which will be able to determine the presence of scars.
The vast majority of children will not require a MCUG and merely require an ultrasound scan. Some children require both an ultrasound scan and a nuclear medicine test.