Diagnostic features and surgical management of congenital hydronephrosis in children

Objective: to improve diagnostic evaluation and surgical management of congenital hydronephrosis in children.

Material and methods: the results of surgical treatment in 165 patients with congenital hydronephrosis were analyzed. The cohort comprised 102 boys and 63 girls aged 1 to 15 years. Depending on disease stage, the patients were divided into three groups: 20 children with grade I hydronephrosis, 120 with grade II–III hydronephrosis, and 25 with grade III–IV hydronephrosis. All patients underwent comprehensive radiographic evaluation. In children with grade I hydronephrosis, surgery was aimed at relieving urinary tract obstruction caused by adhesions and secondary calculi. In the second group, comprising children with grade II–III hydronephrosis, reconstructive surgery was performed using the Anderson–Hynes pyeloplasty technique; in cases with an aberrant vessel, vascular transposition with pelvic flap reconstruction was used. In patients with so called giant hydronephrosis, surgery was performed in two stages: nephrostomy as the first stage, followed by reconstructive surgery as the second stage.

Results: the study showed that, in children with congenital hydronephrosis, ultrasonography, Doppler assessment of the renal vessels, and contrast-enhanced CT are the imaging modalities of choice for diagnosis. Surgical correction should be individualized and targeted, taking into account the child’s physiological reserve and associated urinary tract anomalies.

Conclusion: the findings indicate that congenital hydronephrosis in children is a serious condition requiring timely diagnosis and surgical correction in order to avoid organ-removing procedures. Surgical treatment is advisable during the first year of life, but not earlier than 4–6 months after birth.

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