My child has been diagnosed with fluid in the kidneys before birth?? Should I be worried?

Hydronephrosis (or fluid in the kidney) is a stage during kidney development in the fetus. The fluid collection though seen on ultrasound imaging, is mostly of minor degree, and will disappear with growth. Only in a few instances will the collection need to be further investigated.

My baby has now been born with hydronephrosis? What should I do?

There is no reason to panic. For the first week or two after birth no investigations are warranted (as the baby needs mothers care above anything else). After that an ultrasound will show the extent of fluid collection, which can be graded according to severity from Grade 1 – Grade 5

My baby is one month old and has a Grade 5 Hydronephrosis? Should I go for immediate surgery?

Urgent surgery is never warranted.  Before embarking on surgery, a test called a Diuretic Renogram or DTPA will be requested. This is usually done after 8 to 12 weeks of age.

How does the test decide if surgery is warranted?

This test involves the injection of a tiny amount of radioactive isotope, which is filtered by the kidneys. The time taken for the filtered isotope to drain into the bladder determines the need for surgery. Also an idea of individual renal function is obtained (compared to the other side). This test can be used as a benchmark to assess improvement after surgery.

If surgery is done will there necessarily be a cut?

The kidneys are located at the back of the body and are protected by the lower rib cage. There are two ways in which to approach the kidney for the surgery:

Open Pyeloplasty: This involves a cut on the side or back of the body. The kidney is exposed; obstructed segment is removed and reconnected so that it is dependent (for urine drainage) and wide.

Robot Assisted Laparoscopic Pyeloplasty: This involves making three tiny (8mm) holes and approaching the kidney from the front. The robot gives 3D depth vision, 10 times magnification, and real color. Without disturbing the surrounding organs the obstructed segment is removed and reconnected to established secure drainage of the kidney.

How effective is surgery?

Both Open and Robotic Assisted Laparoscopic approaches have excellent success rates – in excess of 97%.

After surgery how long should we continue to see the doctor?

The follow-up schedule after pyeloplasty is timed visits (usually at 6 monthly intervals) for two years. After two years once the drainage is stable and well established no further doctor visits are warranted.