Urology
Welcome to the Institute for Pediatric Urology at the Komansky Center For Children's Health at NewYork Presbyterian Hospital/Weill Cornell Medical Center.
The Institute for Pediatric Urology specializes in the structure, function, and development of children's kidneys and urinary tracts. Our physicians and nurses are specially trained in pediatric urology to provide your child with expert care. It is our goal to protect the kidneys in young children so that they may grow up healthy. You and your baby have been referred here because of a kidney condition, and we want you to fully understand what that means for your baby.
Please take the time to read this information carefully as we introduce you to the kidney condition called hydronephrosis. We know this is probably new material for you, and it may be confusing, so we are available to answer all of your questions. We want you to understand your child's health, kidney condition, and treatment. Feel free to contact us with your concerns so that we can be as helpful and supportive as possible for you and your child. We encourage you to become actively involved and work together with us to care for your baby.
Neonatal Hydronephrosis
What are kidneys?
The kidneys, located in the back of the abdomen just below the ribs, are important for many bodily functions. One of the kidneys' major functions is to filter blood and remove waste products that are passed out of the body through the urine. The kidneys are connected to thin tubes called ureters, which carry the urine to the bladder. When the kidneys are forming before a child is born, sometimes conditions develop that change the way one or both of the kidneys look or function.
What is hydronephrosis?
Hydronephrosis is a "stretching" or dilation of the inside, or collecting part, of the kidney. It often results from a blockage in the ureter where it joins the kidney that prevents urine from draining into the bladder. Urine is trapped in the kidney and causes it to stretch. Hydronephrosis may also be due to abnormal backwash or "reflux" of urine into the bladder.
How is hydronephrosis detected?
Hydronephrosis is detected with an ultrasound test during pregnancy. This early detection helps prevent infection because infants with hydronephrosis begin receiving antibiotics immediately after birth. Also, physicians can begin further testing soon after birth to determine the extent of the child's condition.
What are the degrees of Hydronephrosis?
Hydronephrosis may range from mild to severe. The severity of hydronephrosis depends on the extent of the blockage and the amount of stretching of the kidney. Children with mild hydronephrosis usually do not have symptoms, the kidneys are minimally (if at all) affected, and the hydronephrosis disappears in the first year of life.
In patients observed with moderate hydronephrosis, kidney function usually does not decrease, kidney growth remains normal, and the degree of hydronephrosis usually does not worsen. Careful observation during the first one to two years of life is required. In some cases the kidney compensates for the hydronephrosis to maintain normal function and some children even get better on their own.
In extremely severe cases of hydronephrosis, damage to normal kidney function may occur. In addition to affecting kidney function, this condition may also cause infection, pain or bleeding. These effects may take months or even years to develop, or in some cases, they may not occur at all.
In infants, the amount of hydronephrosis may appear greater than the actual degree of blockage because of the "stretchiness" of the young tissues. In other words, on an ultrasound exam the hydronephrosis may appear to be worse than the condition really is.
What causes hydronephrosis?
The blockage that produces hydronephrosis is usually the result of a narrowing at the top of the ureter near the kidney that probably developed before the fourth month of pregnancy. Hydronephrosis has never been linked to anything parents have done during pregnancy and is usually not passed from parent to child or found in more than one sibling in a family.
What tests will my child have?
Your child will undergo a number of tests to locate the cause(s) of the hydronephrosis and determine if may have any effect on kidney function. Throughout the testing, you will be able to remain in the examination room to help reassure your baby.
The most common tests performed to carefully examine the condition include:
- An ultrasound (RUS) will be the first test performed to evaluate your baby's kidneys. This is the same test you had during your pregnancy that first detected the hydronephrosis. The ultrasound will provide a good picture of the degree of hydronephrosis and help determine the need for further testing.
- A cystogram (VCUG) will be performed to look for a condition called reflux that may also cause hydronephrosis. In children with reflux, urine flows back into the kidney from the bladder instead of passing out of the body. For the cystogram, a small tube will be inserted into your child's bladder through the urethra, the opening through which urine passes out of the body, and a special liquid will be passed through the tube into the bladder. The liquid will be visible on x-rays that will be taken to see how urine flows in your child's bladder.
- A renal scan (MAG3) may be performed to measure the difference in kidney function between the right and left kidneys and estimate the degree of blockage of urine drainage. This test involves an injection of a small amount of liquid that is recorded as it is filtered by the kidney. A small tube is inserted into the bladder to drain the urine.
How is Hydronephrosis Treated?
After your child has underdone testing, a decision will be made about the method of treatment: observational therapy or surgical therapy.
- Observational Therapy. Observational therapy involves close monitoring of your child's health and kidney growth and function by your physician. In some children, hydronephrosis will gradually improve over time by itself. Therefore, it is possible that this condition will completely go away without surgery and without injury to the kidney. In most situations, kidney growth and function remain normal. In observational therapy, there is no incision and, therefore, no scarring. This is the preferred method and is used when the hydronephrosis is mild. There is a limited chance of infection or decrease in the kidney function, but this is rare. However, in some children, the kidney function may worsen and surgery may be necessary to restore kidney function, though this is an uncommon situation.
- Surgical Therapy. Much less common than observational therapy, surgical therapy involves an operation to relieve the obstruction of the kidney, followed by close monitoring of kidney development after the repair.
The operation is called a pyeloplasty. During the pyeloplasty, the obstructed part of the ureter is removed and the healthy ureter is reattached to the collecting part of the kidney. After the operation, your child remains in the hospital, usually one day. You may stay with your child during this time if you desire. Recovery after surgery usually takes one week.
We were the first in New York to perform robotic pyeloplasty for correcting the obstructed ureter. Using the robot, we are able to eliminate the abdominal scar and improve recovery following surgery. We also perform laparoscopic and open surgical correction.
Each method has its advantages, and selection of your baby's treatment will be based primarily on the degree of hydronephrosis and the baby's age.
If the degree of hydronephrosis is greater, or if observational therapy is ineffective, surgery may be necessary, but surgery does not resolve the problem quickly in most cases. As in any surgical procedure, there is a degree of scarring, but with modern techniques we are able to reduce this substantially. There is also the possibility of complications related to anesthesia or the surgery itself, but once again, they are rare occurrences.
In the past, hydronephrosis was not routinely detected in children until the age of three or four and surgery was the only option for children this age. Now, with new therapy approaches and the development of prenatal testing, children are being diagnosed early and treatment options have improved. Observation or surgery is indicated for moderate to severe hydronephrosis; however, current testing cannot predict which patients will get better on their own. At Weill Cornell, our physicians will work with you to provide the best treatment for your baby.
Contact
- Institute for Pediatric Urology
- Telephone: (212) 746-5337
