Antenatally Diagnosed Hydronephrosis in a 2.5-Month-Old Infant Treated by Pyeloplasty Institute of Urology, Jaipur

Antenatally Diagnosed Hydronephrosis in a 2.5-Month-Old Infant Treated by Pyeloplasty Institute of Urology, Jaipur: Hydronephrosis, or dilation of the kidney’s collecting system, is a relatively common prenatal finding that warrants careful evaluation to determine underlying causes. This report highlights the case of a 2.5-month-old infant diagnosed with hydronephrosis during an antenatal scan. Timely diagnosis enabled precise management by the senior urologist team at the Institute of Urology, Jaipur.

Clinical Presentation and History

A routine antenatal ultrasound revealed hydronephrosis in the left kidney. The mother’s obstetrician recommended further monitoring, and the parents were counseled to seek urology consultation after delivery. The infant, born full-term via normal delivery, appeared healthy at birth with no overt symptoms. However, follow-up imaging was prioritized to assess the severity and underlying etiology.

Investigations

1. Ultrasound (USG) of the Abdomen
   
   • The USG confirmed significant dilation of the left renal pelvis and calyces. The right kidney appeared normal.
     
2. CT Urography
   
   • A contrast-enhanced CT scan showed severe left-sided hydronephrosis with narrowing at the pelvi-ureteric junction (PUJ), suggestive of obstruction. No evidence of contralateral abnormalities was found.
     
3. DTPA Renal Scan
   
   • A diuretic renogram using Tc-99m diethylenetriamine pentaacetate (DTPA) demonstrated delayed drainage of the left kidney with a moderately compromised left renal function and differential renal function of 37% on the affected side, confirming significant obstruction at the PUJ.

Diagnosis

Based on the clinical and radiological findings, the infant was diagnosed with Pelvi-Ureteric Junction (PUJ) Obstruction, a common cause of hydronephrosis in infants and children.

Treatment Plan

The senior urology team, comprising Dr. M. Roychowdhury and Dr. Rajan Bansal, decided on Dismembered Anderson-Hynes Pyeloplasty with Double-J (DJ) Stenting as the most appropriate surgical intervention. This decision was reached after detailed discussions with the parents about the procedure, potential risks, and expected outcomes.

Procedure Details

• The surgery involved excision of the narrowed PUJ segment, followed by re-anastomosis of the renal pelvis to the proximal ureter to establish unobstructed urine flow.
• A DJ stent was placed to ensure ureteral patency and facilitate healing.
• The procedure was performed under general anesthesia, and intraoperative findings corroborated the diagnosis of significant PUJ obstruction.

Outcome

• The infant tolerated the surgery well and recovered uneventfully. Postoperative monitoring showed no complications, and the parents were counseled on postoperative care and follow-up.
• The DJ stent is planned for removal after 4-6 months to allow optimal healing and function.

Follow-Up and Prognosis

1. Postoperative Imaging:
   • A repeat DTPA scan is scheduled three months post-surgery to evaluate residual kidney function and confirm unobstructed drainage.
     
2. Stent Removal:
   • The DJ stent will be removed endoscopically after 4-6 months, contingent upon satisfactory recovery.
     
3. Prognosis:
   • The prognosis is excellent, with anticipated restoration of normal urinary drainage and preservation of renal function on the affected side.

Discussion

This case underscores the importance of antenatal ultrasounds in identifying urological anomalies early. Timely diagnosis and referral enabled optimal management, reducing the risk of complications such as renal function loss, urinary infections, or hypertension.

Relevance of Early Intervention:
The early surgical correction in this case prevented progressive renal damage and ensured a favorable outcome. Emerging technologies such as advanced imaging and minimally invasive surgical approaches continue to enhance the management of PUJ obstruction.

Conclusion

This case highlights the critical role of antenatal screening in diagnosing hydronephrosis and the multidisciplinary approach needed for effective management. The successful surgical outcome demonstrates the expertise and commitment of the urology team at the Institute of Urology, Jaipur. This hospital is known for treating paediatric urology cases with utmost care and compassion ensuring optimum patient satisfaction.