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Home >> Pediatric Urology >> Hydronephrosis >> Treatment
Hydronephrosis - Treatment
Overview | Diagnosis | Treatment | FAQ
The cause and degree of obstruction plus the severity of symptoms dictate the type and immediacy of treatment. Many times prenatal hydronephrosis may resolve on its own, over time. If hydronephrosis is caused by a stone that is small enough to pass, the situation is usually treated expectantly; that is, with medication, plenty of fluids, and a tincture of time. Similarly, if a UPJ obstruction is asymptomatic , especially if it is mild, it may not require treatment. On the other hand, if there is a severe obstruction of the urinary tract, intervention is usually required. Treatment of a symptomatic stone in the kidney or ureter is discussed elsewhere under the heading of stone disease.
If a urethral ‘valve’ is identified, a procedure called transurethral incision of the urethral valve is performed. Ureteral reflux will be typically managed nonoperatively at first. A ureteral obstruction will need to be fixed.
If a UPJ obstruction causes pain, high blood pressure, reduced kidney function, kidney stones, or kidney infection, treatment is recommended.
UPJ repair (pyeloplasty)
Dismembered Pyeloplasty
Traditionally, a symptomatic UPJ obstruction is repaired with open surgery by dismembering (excising) the obstructed area where the ureter enters the renal pelvis. A plastic surgical type of repair is performed to reconnect the severed end of the ureter to the renal pelvis. The success rate of this procedure, which is called a dismembered pyeloplasty, is 95%. In some patients a temporary stent, or small plastic flexible straw may be unserted for the healing period.
If a patient has a recurrent obstruction, a minimally invasive procedure, called an endopyelotomy, may be a consideration. A variety of techniques and types of medical devises can be used, including the laser or an endopyrlotomy balloon. Sometimes we can get thennarriwed area by using a uretoscope, and sometimes we have to make a small incison to access the kidney.
For further information about an endopyelotomy procedure, click here.
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