Antenatal hidronefrozun postnatal güncel yönetimi

Abstract

Antenatal hidronefrozlu bir hastanın postnatal değerlendirilmesindeki en kritik nokta, böbrek fonksiyonları riskte olan hasta grubunu erken dönemde tesbit ederek izlem ve tedavi protokollerini oluşturmaktır. Ancak tüm antenatal hidronefrozlu bebeklerin postnatal dönemde rutin radyolojik değerlendirmelere alınması da radyasyon riski taşımaktadır ve ek maliyetler getirmektedir. Özellikle vezikoüreteral reflü taramasında kullanılan işeme sistoüretrografisi hem hastada hem de ailede anksiyete oluşturmaktadır.Antenatal hidronefrozlu bir bebeğin postnatal izlem ve tedavisi, hidronefrozun izole olup olmamasına, hidronefrozun derecesine, diferansiyel böbrek fonksiyonlarına, hastanın semptomatik ya da asemptomik olmasına göre farklılıklar gösterir. İzole hafif antenatal hidronefrozlar genellikle spontan regresyon gösterir. Son zamanlarda, asemptomatik olguların ayrıntılı radyolojik değerlendirmeye alınmasına ve antibiyotik profilaksisi uygulamasına gerek olmadığı yönünde görüşler ağırlık kazanmaktadır. Orta ve ileri derecede antenatal hidronefrozlarda ise üriner anomali görülme insidansı daha yüksektir. Bu hasta grubunda hidronefroza neden olan üreteropelvik bileşke darlığı, vezikoüreteral reflü ve posterior üretral valv gibi patolojileri erken dönemde tanımlamak, gerekli izlem ve tedavinin planlaması ve üst üriner sistemin korunması açısından önem taşımaktadır. Vezikoüreteral reflülü ve üreteropelvik bileşke darlığı olan olgularda böbrek fonksiyonları açısından risk faktörleri dikkate alınarak hastanın konservatif olarak izlenmesine ya da cerrahi yapılmasına karar verilir. Vezikoüreteral reflü ve üreteropelvik bileşke darlığı için açık cerrahi yöntemlerin sonuçları son derece başarılı iken son zamanlarda minimal invaziv tekniklerin de benzer başarıları yakaladıkları bildirilmektedir.

Keywords

• Antenatal hidronefroz,postnatal yönetim,üreteropelvik bileşke darlığı,vezikoüreteral reflü,posterior üretral valv

Postnatal current management of antenatal hydronephrosis

Abstract

The most critical point in the postnatal evaluation of a patient with antenatal hydronephrosis is to diagnose the patients whose renal fonctions are at risk in an early stage and to plan the follow-up and treatment modalities in this group of patients. However, routine radiological evaluation of every patient with antanatal hydronephrosis carries the risk of radiation with additional cost. Moreover, performance of voiding cysto-urethra graphy, for the diagnosis of vesicoureteral reflux, causes anxiety for both the patient and the parents. The postnatal evaluation and management of patients with antenatal hydronephrosis vary depending on the degree of hydronephrosis, the presence of associated anomalies, the differencial renal functions and the clinical findings of the patient. Isolated mild antenatal hydronephrosis usually regresses spontaneously. The latest consensus suggests that extensive radiological evaluation and antibiotic prophylaxis in asympthomatic patients with mild antenatal hydronephrosis are not necessary. However, the insidence of significant urological pathologies in moderate and severe antenatal hydronephrosis is high. Therefore, diagnosing the underlying pathologies such as ureteropelvic junction obstruction, vesicouereteral reflux and posterir urethral valv in the early period and planning the management strategies are important to prevent the upper urinary tractus. Patients with vesicoureteral reflux and ureteropelvic junction obstruction are either operated or conservatively followed-up depending on the risk factors affecting the renal functions of the patient. Open surgical techniques for the treatment of vesicouereteral reflux and ureteropelvic junction obstruction are very successful. However, the same success rates have also been reported recently by minimal invazive surgery

Keywords

• Antenatal hydronephrosis,postnatal management,ureteropelvic junction obstruction,vesicoureteral reflux,posterior uretral valv

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