A case of Undetected Congenital Primary Obstructed Megaureter (POM)

Primary obstructed Megaureter (POM) defined as dilatation of ureter bigger than the normal size with or without renal pelvis dilatation. POM was first described in 1923 by Clark [1]. This is the second most common aetiology causing hydronephrosis in infant and it more prevalence in boys compared with girls. Early detection of POM is important to guide us in the long management of the patient and better outcome. Surgical intervention still mainstay treatment for POM in failure of conservative management.

Postnatal outcomes of babies diagnosed with hydronephrosis in utero in a tertiary care centre in India over half a decade

Background Prenatal hydronephrosis is defined as the dilatation of the fetal renal pelvis and/or calyces and is the commonest anomaly detected in utero Methods This was a retrospective study to look at how well 148 antenatally detected cases of fetal hydronephrosis correlated with postnatal evaluation. Results Antenatal hydronephrosis was detected with a prevalence of 0.33%. The mean gestational age at diagnosis was 25.48 [standard deviation (SD) 6.36]. One hundred and sixteen (78.3%) fetuses had serial ultrasound scans during pregnancy to look for the progression of the condition. At the time of diagnosis, 30.1% of the fetuses were diagnosed to have mild hydronephrosis, 43.9% to have moderate hydronephrosis and 25.8% to have severe hydronephrosis. Follow-up ultrasounds during the prenatal period, 65% showed progression of the renal pelvis dilatation, 25.8% showed stable disease and 9.1% showed resolution on their subsequent scan. Almost half (46%) were found to have transient/physiological hydronephrosis. Thirty-one (20.9%) of the babies required an operation. An anteroposterior renal pelvis diameter (APD) of the fetal renal pelvis ≥17.5 mm can predict the need for surgery with a sensitivity of 70% and a specificity of 76.6%. Conclusion Counselling and decisions must be based on a series of ultrasound scans rather than a single evaluation. We use a cut-off of 17.5 mm as an indicator of possible postnatal surgical intervention.

Endocrinology

This chapter provides background information on fetal and neonatal renal development, physiology, and function. Detailed information is given on management of common, antenatally diagnosed, renal anomalies (renal pelvis dilatation/hydronephrosis); post-natal diagnoses (hypospadius, hydrocele); posterior urethral valves; polycystic kidney disease; and rarer diagnoses. There is a guideline on the management of acute renal failure in the newborn, and information on dialysis.