Obstruction/reflux Flashcards
international reflux study committee grading of reflux
grade 1 reflux into ureter only
grade 2 reflux into renal pelvis
grade 3 mild dilatation of ureter and pc system
grade 4 - moderate dilatation, tortuous ureter, blunting fornices but papillary impression remain
grade 5 - severe dilataion, tortuous, loss of fornices and papillary impressions
incidence of PUV
1 in 4000
initial management of PUV
US on day 2 with creatinine – when creatinine not reflective of maternal
Then divide into two groups
Normal creatinine, passing urine, HUN mild – can give trimethoprim 2mg/kg orally at night, MCUG as OP, review result referral to local paed urology department
If plasma create raised, markedly abnormal US, not passing urine, trimethoprim 2mg/kg at night, catheterise urethral or SPC, monitor post ob diuresis can be up to 8-10/kg/hr
If abnormal creatinine measured bicarb as become acidotic and may require oral bicarb
Abnormal renal function involve paed nephrologist
initial management of PUV
US on day 2 with creatinine – when creatinine not reflective of maternal
Then divide into two groups
Normal creatinine, passing urine, HUN mild – can give trimethoprim 2mg/kg orally at night, MCUG as OP, review result referral to local paed urology department
If plasma create raised, markedly abnormal US, not passing urine, trimethoprim 2mg/kg at night, catheterise urethral or SPC, monitor post ob diuresis can be up to 8-10/kg/hr
If abnormal creatinine measured bicarb as become acidotic and may require oral bicarb
Abnormal renal function involve paed nephrologist
then MCUG
then cystoscopy and fulguration of valves
Repeat cystoscopy at 6 weeks to 3 months postop
4 types megaureter
reflux - VUR management
obstructing - conservative, stent +/- dilatation, refluxing implant, ureterostomy, reimplant
obstructing and refluxing - reimplant
non reflux non obstructive
definition mega ureter
> 7mm on 3rd trimester US
invesitgations megaureter
US check bladder
MCUG any reflux?
MAG3 - obstruction and differential function
cystoscopy and retrograde in selected cases
causes secondary megaureter
PUV, urinary stones, bladder dysfunction, ureterocele, ectopic ureter, diabetes insipidus
indications surgery in megaureter
how many require intervention
10-30%, usually in first 2 years life majority need no intervention esp if below 10mm give abx to all when born impaired function DRF <40% serial drop renal function evidence increasing HN on US scans infection episodes
surgery options megaureter
stent temporary with vuj dilatation +/- cutting can cure in 50% cases
then refluxing reimplant temporary, can do ureterostomy
then non refluxing reimplant - ureteroneocystotomy which will need end tapering
don;t forget circumcision if infections!
causes antenatal hydronephrosis based main post natal diagnosis
watson paper 50% non specific dilatation 11% PUJO 12% VUR 6% MCDK 4% duplex ureterocele 2% VUJO 1% PUV
definition AN hydro
7 or more mm in third trimester UK NHS foetal anomaly screening
measured AP at renal hilum
SFU grading AN hydro
1= prominent pelvis
2 = dilated pelvis, some calyces visible
3 - dilated pelvis and calyces all seen
4= greater pelvic and calyceal dilatation, cortical thinning
who needs post natal ix of AN HN (4)
unilateral RPD >10mm at 32 weeks
bilateral RPD with APD >6mm at any gestational age
RPD in solitary kidney
RPD with ureteric dilatation
which AN will resolve
APD <12mm 98% will resolve stabilised or improved on FU
