Hydronephrosis/PUJ Obstruction
Synthetic tape surgery for stress incontinence
Hydronephrosis (swelling of the kidney) and PUJ Obstruction (pelviureteric junction obstruction) are common problems in children. About 20% of fetus will show swelling in one kidney in an antenatal scan of the mother. However, many of these will resolve with time. In all children who had fetal hydronephrosis, an ultrasonogram is indicated after birth. Depending on the findings, this may be followed up in some children by a nuclear scan at about 6weeks. Some children will also need to undergo an Xray called the micturating cystourethrogram. Children with drop in kidney function or worsening hydronephrosis may require surgical correction called a pyeloplasty. This can now be accomplished laparoscopically esp in older children. Following surgery, hydronephrosis shows a slow regression and the kidney function usually either stabilizes or improves in about 95% of children.
Neurogenic bladder
Urodynamics tracing showing very poor bladder compliance and dangerously high pressures in a 3y boy
Bladder dysfunction in children is an important cause of preventable kidney failure. Serious life threatening problems in patients with spinal problems do not usually come from the spine-they come from the bladder! Unrecognized or untreated neurogenic bladder can rapidly damage kidney function. Once there is irreparable function loss, the long term consequences are tragic. Most such children will develop advanced kidney failure around the time of puberty.
This distressing problem is completely preventable! Management of neurogenic bladder management CANNOT wait for the child to grow up. It must be managed on priority before any kidney damage occurs. Urodynamics is an important component of assessment. Careful, systematic treatment is the key to good quality care.
Dr Sanjay Sinha is handling one of the busiest urodynamics centres in India and the centre gets referrals from across the length and breadth of India.